{"hospital_name":"Memorial Healthcare","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["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"},"type_2_npi":["1063414233","1316008006"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Jorri Tremain"},"modifier_information":[{"description":"Medicaid level of care 6, as defined by each state","code":"U6","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes","code":"TB","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"New Business Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cofinity","plan_name":"Humana PPOM All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"AHL & ASR Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"HPI Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Livingston County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Community  HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"McLaren Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shiawassee County","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trinity Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Dual Medicare/Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Washtenaw","plan_name":"Medicaid 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 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1.3%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2502991","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":2302.41,"discounted_cash":1841.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"Exparel 1.3% 10 ML VIAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2502992","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250013309","type":"NDC"}],"standard_charges":[{"gross_charge":1393.48,"discounted_cash":1114.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"Suboxone 8/2mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2503003","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0574","type":"HCPCS"},{"code":"50268014515","type":"NDC"}],"standard_charges":[{"gross_charge":50.76,"discounted_cash":40.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"Suboxone 2/0.5mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2503004","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268014415","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 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SR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2503007","type":"CDM"},{"code":"637","type":"RC"},{"code":"31722006601","type":"NDC"}],"standard_charges":[{"gross_charge":30.24,"discounted_cash":24.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 MG"}]},{"description":"Wellbutrin SR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2503008","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084070825","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 150 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NACL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2503647","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7999","type":"HCPCS"},{"code":"70092162303","type":"NDC"}],"standard_charges":[{"gross_charge":140.4,"discounted_cash":112.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 ML"}]},{"description":"Kefzol","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2503648","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"gross_charge":86.62,"discounted_cash":69.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 50 ML"}]},{"description":"CEFAZOLIN 2 G/20 ML-WATER 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7.5/325","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2517061","type":"CDM"},{"code":"637","type":"RC"},{"code":"00406052262","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"Percocet 10mg/325mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2517062","type":"CDM"},{"code":"637","type":"RC"},{"code":"50268064615","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 EACH"}]},{"description":"Oxycontin 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MG"}]},{"description":"ULTOMIRIS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520326","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":29394.36,"discounted_cash":23515.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 3 ML"}]},{"description":"ULTOMIRIS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520327","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002801","type":"NDC"}],"standard_charges":[{"gross_charge":107779.32,"discounted_cash":86223.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 11 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(EUA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520330","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":3897.46,"discounted_cash":3117.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 100 MG"}]},{"description":"Cinqair","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520331","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2786","type":"HCPCS"},{"code":"59310061031","type":"NDC"}],"standard_charges":[{"gross_charge":5680.0,"discounted_cash":4544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 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MG"}]},{"description":"XIFAXAN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520341","type":"CDM"},{"code":"637","type":"RC"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":334.20,"discounted_cash":267.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 550 MG"}]},{"description":"SKYRIZI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520350","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2327","type":"HCPCS"},{"code":"00074501501","type":"NDC"}],"standard_charges":[{"gross_charge":46169.55,"discounted_cash":36935.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"RisperDAL 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Consta","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520361","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030711","type":"NDC"}],"standard_charges":[{"gross_charge":5323.84,"discounted_cash":4259.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"RisperDAL Consta","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520362","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030611","type":"NDC"}],"standard_charges":[{"gross_charge":3549.10,"discounted_cash":2839.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 ML"}]},{"description":"RisperDAL M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520363","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746003022","type":"NDC"}],"standard_charges":[{"gross_charge":53.7,"discounted_cash":42.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 MG"}]},{"description":"RisperDAL M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520364","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746002022","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 MG"}]},{"description":"RisperDAL M","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520365","type":"CDM"},{"code":"637","type":"RC"},{"code":"59746001032","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"discounted_cash":23.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 MG"}]},{"description":"RisperDAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520367","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084027301","type":"NDC"}],"standard_charges":[{"gross_charge":45.54,"discounted_cash":36.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 MG"}]},{"description":"rifAMPin","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520369","type":"CDM"},{"code":"637","type":"RC"},{"code":"60687058601","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":6.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 300 MG"}]},{"description":"RisperDAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520372","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084027201","type":"NDC"}],"standard_charges":[{"gross_charge":27.24,"discounted_cash":21.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 MG"}]},{"description":"RisperDAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520374","type":"CDM"},{"code":"637","type":"RC"},{"code":"27808000201","type":"NDC"}],"standard_charges":[{"gross_charge":89.22,"discounted_cash":71.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1 ML"}]},{"description":"RisperDAL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520377","type":"CDM"},{"code":"637","type":"RC"},{"code":"68084027001","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.25 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MG"}]},{"description":"Xarelto","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520389","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057910","type":"NDC"}],"standard_charges":[{"gross_charge":119.64,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 MG"}]},{"description":"Rituxan","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520391","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":5167.36,"discounted_cash":4133.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"Rituxan 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state"}]},{"description":"Rocephin","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520416","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"gross_charge":161.1,"discounted_cash":128.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 500 MG"}]},{"description":"Zemuron","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520421","type":"CDM"},{"code":"250","type":"RC"},{"code":"71266200201","type":"NDC"}],"standard_charges":[{"gross_charge":51.6,"discounted_cash":41.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 5 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ML"}]},{"description":"NPLATE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520440","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":6882.65,"discounted_cash":5506.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 125 MCG"}]},{"description":"NPlate","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520441","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2802","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":13765.1,"discounted_cash":11012.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 250 MCG"}]},{"description":"LEQVIO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520443","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":17938.65,"discounted_cash":14350.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 1.5 ML"}]},{"description":"EVENITY (2 SYRINGES)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520444","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":13144.6,"discounted_cash":10515.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2.34 ML"}]},{"description":"Naropin 20mL 1%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520446","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028821","type":"NDC"}],"standard_charges":[{"gross_charge":136.2,"discounted_cash":108.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"Naropin 0.2%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520453","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028513","type":"NDC"}],"standard_charges":[{"gross_charge":33.12,"discounted_cash":26.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 10 ML"}]},{"description":"Requip","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520454","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687057701","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.25 MG"}]},{"description":"Requip","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520456","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332003131","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 0.5 MG"}]},{"description":"Requip","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520457","type":"CDM"},{"code":"637","type":"RC"},{"code":"62332003331","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 2 MG"}]},{"description":"Naropin 0.5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520459","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001910","type":"NDC"}],"standard_charges":[{"gross_charge":42.06,"discounted_cash":33.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE HCL 1MG INJ-P","code_information":[{"code":"2520460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":56.8,"setting":"both","modifier_code":["U6"],"billing_class":"professional","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier U6: Medicaid level of care 6, as defined by each state"}]},{"description":"ROPIVACAINE 0.5% 150 MG/30 ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"2520460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002301","type":"NDC"}],"standard_charges":[{"gross_charge":27.50,"discounted_cash":22.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy | NDC EA = 30 ML"}]},{"description":"ENTRESTO 24 MG-26 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