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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hdr elctrnc skn surf brchytx","code_information":[{"code":"0394T","type":"HCPCS"}],"standard_charges":[{"minimum":201.88,"maximum":201.88,"setting":"both","payers_information":[{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":201.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Waterjet prostate abltj cmpl","code_information":[{"code":"0421T","type":"HCPCS"}],"standard_charges":[{"minimum":171.28,"maximum":1402.11,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":261.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1075.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1402.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":949.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":956.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":517.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fxjl abl lsr 1st 100 sq cm","code_information":[{"code":"0479T","type":"HCPCS"}],"standard_charges":[{"minimum":195.22,"maximum":195.22,"setting":"both","payers_information":[{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":195.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Initial prenatal care visit","code_information":[{"code":"0500F","type":"HCPCS"}],"standard_charges":[{"minimum":26.16,"maximum":74.01,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Subsequent prenatal care","code_information":[{"code":"0502F","type":"HCPCS"}],"standard_charges":[{"minimum":20.01,"maximum":350.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":350.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Postpartum care visit","code_information":[{"code":"0503F","type":"HCPCS"}],"standard_charges":[{"minimum":357.00,"maximum":4143.84,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2922.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":357.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3982.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2638.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1435.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2638.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1278.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4143.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2304.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2638.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1250.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1069.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1462.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2676.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1257.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1345.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2074.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1446.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1959.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1278.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":796.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tcat rmvl/dblk icar mas perq","code_information":[{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"minimum":574.62,"maximum":1829.89,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":574.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1494.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1829.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"minimum":41.95,"maximum":104.58,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fna bx w/us gdn ea addl","code_information":[{"code":"10006","type":"HCPCS"}],"standard_charges":[{"minimum":39.98,"maximum":109.35,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"minimum":41.27,"maximum":289.38,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":996.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":283.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":382.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Acne surgery","code_information":[{"code":"10040","type":"HCPCS"}],"standard_charges":[{"minimum":40.23,"maximum":40.23,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10060","type":"HCPCS"}],"standard_charges":[{"minimum":44.00,"maximum":829.51,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1633.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":399.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":692.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"minimum":640.62,"maximum":2887.66,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":928.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1366.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":640.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1139.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2845.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"minimum":42.60,"maximum":1334.83,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1334.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":165.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":607.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb musc/fascia 20 sq cm/<","code_information":[{"code":"11043","type":"HCPCS"}],"standard_charges":[{"minimum":111.10,"maximum":1369.55,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":213.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":201.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1369.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":211.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":697.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":181.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":947.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":444.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":164.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":416.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":946.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1125.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":238.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":390.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":423.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1211.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":284.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":692.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"minimum":157.54,"maximum":1781.26,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":641.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":237.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":242.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":775.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":219.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":394.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1632.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1321.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":377.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb subq tissue add-on","code_information":[{"code":"11045","type":"HCPCS"}],"standard_charges":[{"minimum":61.65,"maximum":1334.83,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1334.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":307.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1039.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb musc/fascia add-on","code_information":[{"code":"11046","type":"HCPCS"}],"standard_charges":[{"minimum":129.31,"maximum":2775.51,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1612.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2208.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deb bone add-on","code_information":[{"code":"11047","type":"HCPCS"}],"standard_charges":[{"minimum":394.76,"maximum":2887.66,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":394.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":223.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Trim skin lesions 2 to 4","code_information":[{"code":"11056","type":"HCPCS"}],"standard_charges":[{"minimum":21.54,"maximum":133.89,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Trim skin lesions over 4","code_information":[{"code":"11057","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":68.01,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"minimum":31.05,"maximum":272.62,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":272.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":212.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"minimum":40.09,"maximum":656.33,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":228.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Punch bx skin ea sep/addl","code_information":[{"code":"11105","type":"HCPCS"}],"standard_charges":[{"minimum":40.09,"maximum":228.40,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1125.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":233.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"minimum":222.53,"maximum":704.91,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":516.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":222.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":360.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":320.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"minimum":244.36,"maximum":1219.12,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"minimum":116.88,"maximum":525.33,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"minimum":305.05,"maximum":669.83,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":614.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"minimum":401.44,"maximum":718.27,"setting":"both","payers_information":[{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":401.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"minimum":223.67,"maximum":2189.12,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1047.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":938.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"minimum":713.71,"maximum":728.72,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1505.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1505.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":110.28,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"minimum":19.61,"maximum":121.73,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"minimum":17.19,"maximum":150.01,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":177.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":983.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":118.27,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1111.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove/insert drug implant","code_information":[{"code":"11983","type":"HCPCS"}],"standard_charges":[{"minimum":136.79,"maximum":1260.06,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1260.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":219.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr s/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"12001","type":"HCPCS"}],"standard_charges":[{"minimum":51.46,"maximum":232.19,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":232.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":172.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr s/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"12002","type":"HCPCS"}],"standard_charges":[{"minimum":76.00,"maximum":320.71,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":176.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":293.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":320.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr s/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"12004","type":"HCPCS"}],"standard_charges":[{"minimum":100.65,"maximum":163.50,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"minimum":93.97,"maximum":1451.91,"setting":"both","payers_information":[{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1451.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":379.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr f/e/e/n/l/m 2.5 cm/<","code_information":[{"code":"12011","type":"HCPCS"}],"standard_charges":[{"minimum":38.62,"maximum":236.09,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":214.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr f/e/e/n/l/m 2.6-5.0 cm","code_information":[{"code":"12013","type":"HCPCS"}],"standard_charges":[{"minimum":30.00,"maximum":803.09,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":210.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":803.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":344.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":238.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr f/e/e/n/l/m 5.1-7.5 cm","code_information":[{"code":"12014","type":"HCPCS"}],"standard_charges":[{"minimum":115.18,"maximum":986.17,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"minimum":25.08,"maximum":338.97,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":314.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Closure of split wound","code_information":[{"code":"12020","type":"HCPCS"}],"standard_charges":[{"minimum":539.52,"maximum":539.52,"setting":"both","payers_information":[{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"minimum":122.19,"maximum":1316.70,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":275.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":443.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Intmd rpr n-hf/genit7.6-12.5","code_information":[{"code":"12044","type":"HCPCS"}],"standard_charges":[{"minimum":393.63,"maximum":393.63,"setting":"both","payers_information":[{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":393.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"minimum":116.55,"maximum":1047.75,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":347.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":884.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":271.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1005.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1047.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":247.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"minimum":103.87,"maximum":1292.51,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":631.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":266.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1292.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":301.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":299.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":551.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cmplx rpr s/a/l addl 5 cm/>","code_information":[{"code":"13122","type":"HCPCS"}],"standard_charges":[{"minimum":550.63,"maximum":2882.77,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":348.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":448.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"minimum":626.70,"maximum":1136.64,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1047.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":796.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"minimum":330.21,"maximum":1583.87,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Destruct premalg les 2-14","code_information":[{"code":"17003","type":"HCPCS"}],"standard_charges":[{"minimum":61.26,"maximum":233.40,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":233.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":197.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"minimum":50.00,"maximum":254.59,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Chemical cautery tissue","code_information":[{"code":"17250","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":10.00,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"minimum":149.16,"maximum":227.95,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Inj tendon origin/insertion","code_information":[{"code":"20551","type":"HCPCS"}],"standard_charges":[{"minimum":75.75,"maximum":232.33,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Inject trigger points 3/>","code_information":[{"code":"20553","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":68.06,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20604","type":"HCPCS"}],"standard_charges":[{"minimum":51.80,"maximum":51.80,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20605","type":"HCPCS"}],"standard_charges":[{"minimum":43.81,"maximum":145.96,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"minimum":43.44,"maximum":48.85,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20610","type":"HCPCS"}],"standard_charges":[{"minimum":38.29,"maximum":382.84,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":177.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":382.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20611","type":"HCPCS"}],"standard_charges":[{"minimum":38.24,"maximum":357.22,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":198.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":357.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":233.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1679.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3511.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2284.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2035.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29824","type":"HCPCS"}],"standard_charges":[{"minimum":1214.70,"maximum":3947.27,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1898.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2694.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1683.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1214.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1092.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2160.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3034.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2556.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3067.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2224.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3947.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1900.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1688.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1214.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2252.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2031.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Arthroscop rotator cuff repr","code_information":[{"code":"29827","type":"HCPCS"}],"standard_charges":[{"minimum":218.93,"maximum":3947.27,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1143.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":742.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":667.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":322.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1140.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":777.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29881","type":"HCPCS"}],"standard_charges":[{"minimum":121.44,"maximum":2232.49,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1045.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2232.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1167.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1101.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1716.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":796.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Repair upper jaw fistula","code_information":[{"code":"30580","type":"HCPCS"}],"standard_charges":[{"minimum":1375.73,"maximum":1375.73,"setting":"both","payers_information":[{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1375.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ablate inf turbinate submuc","code_information":[{"code":"30802","type":"HCPCS"}],"standard_charges":[{"minimum":1324.35,"maximum":1324.35,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":374.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1996.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laryngoscopy for aspiration","code_information":[{"code":"31515","type":"HCPCS"}],"standard_charges":[{"minimum":3015.35,"maximum":3015.35,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":423.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"minimum":353.05,"maximum":390.35,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":923.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"minimum":24.81,"maximum":3583.60,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":409.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1526.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":523.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1321.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1603.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1979.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1104.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":462.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Insert cath pleura w/ image","code_information":[{"code":"32557","type":"HCPCS"}],"standard_charges":[{"minimum":121.80,"maximum":2519.75,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":346.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1638.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2519.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":265.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Treat pleurodesis w/agent","code_information":[{"code":"32560","type":"HCPCS"}],"standard_charges":[{"minimum":1009.94,"maximum":1840.80,"setting":"both","payers_information":[{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1345.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1036.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1009.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Lyse chest fibrin init day","code_information":[{"code":"32561","type":"HCPCS"}],"standard_charges":[{"minimum":1246.05,"maximum":2780.84,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2780.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":829.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":950.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":554.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4081.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2748.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":672.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":739.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":755.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Insert electrd/pm cath sngl","code_information":[{"code":"33210","type":"HCPCS"}],"standard_charges":[{"minimum":1001.41,"maximum":3614.10,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":811.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of pm generator","code_information":[{"code":"33233","type":"HCPCS"}],"standard_charges":[{"minimum":2216.89,"maximum":4551.52,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4551.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove pulse generator","code_information":[{"code":"33241","type":"HCPCS"}],"standard_charges":[{"minimum":1700.66,"maximum":2930.88,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1700.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove eltrd/thoracotomy","code_information":[{"code":"33243","type":"HCPCS"}],"standard_charges":[{"minimum":1860.73,"maximum":1860.73,"setting":"both","payers_information":[{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1527.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2066.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1511.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2331.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ablate atria lmtd add-on","code_information":[{"code":"33257","type":"HCPCS"}],"standard_charges":[{"minimum":3812.49,"maximum":4857.34,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4857.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4019.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ablate atria w/bypass add-on","code_information":[{"code":"33259","type":"HCPCS"}],"standard_charges":[{"minimum":2142.23,"maximum":8864.89,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4881.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6185.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4668.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8864.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5238.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2142.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rmvl& replc pulse gen 1 lead","code_information":[{"code":"33262","type":"HCPCS"}],"standard_charges":[{"minimum":363.50,"maximum":363.50,"setting":"both","payers_information":[{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":363.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rmvl & rplcmt dfb gen 2 lead","code_information":[{"code":"33263","type":"HCPCS"}],"standard_charges":[{"minimum":233.84,"maximum":377.08,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":375.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":233.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":377.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":345.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rmvl & rplcmt dfb gen mlt ld","code_information":[{"code":"33264","type":"HCPCS"}],"standard_charges":[{"minimum":307.91,"maximum":520.87,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":484.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":389.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":307.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":387.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Excl laa open any method","code_information":[{"code":"33267","type":"HCPCS"}],"standard_charges":[{"minimum":1648.54,"maximum":1648.54,"setting":"both","payers_information":[{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1648.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Excl laa opn oth px any meth","code_information":[{"code":"33268","type":"HCPCS"}],"standard_charges":[{"minimum":1937.81,"maximum":5391.75,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5391.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1937.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5361.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3748.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5378.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Excl laa thrscp any method","code_information":[{"code":"33269","type":"HCPCS"}],"standard_charges":[{"minimum":2164.35,"maximum":2164.35,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2164.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tcat insj/rpl perm ldls pm","code_information":[{"code":"33274","type":"HCPCS"}],"standard_charges":[{"minimum":589.56,"maximum":2604.41,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":908.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1615.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":589.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1513.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2604.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Implant pat-active ht record","code_information":[{"code":"33282","type":"HCPCS"}],"standard_charges":[{"minimum":2111.45,"maximum":2111.45,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2111.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Insj subq car rhythm mntr","code_information":[{"code":"33285","type":"HCPCS"}],"standard_charges":[{"minimum":70.38,"maximum":1287.72,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1201.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1132.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":548.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3378.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cabg artery-vein two","code_information":[{"code":"33518","type":"HCPCS"}],"standard_charges":[{"minimum":2350.72,"maximum":6983.53,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4620.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3531.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cabg artery-vein three","code_information":[{"code":"33519","type":"HCPCS"}],"standard_charges":[{"minimum":1067.43,"maximum":7430.56,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6028.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5227.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3306.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Coronary artery bypass/reop","code_information":[{"code":"33530","type":"HCPCS"}],"standard_charges":[{"minimum":4047.75,"maximum":4255.82,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ins cath ren art 2nd+ unilat","code_information":[{"code":"36253","type":"HCPCS"}],"standard_charges":[{"minimum":704.21,"maximum":2874.75,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2739.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Non-routine bl draw 3/> yrs","code_information":[{"code":"36410","type":"HCPCS"}],"standard_charges":[{"minimum":597.21,"maximum":1087.72,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1069.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Injection therapy of vein","code_information":[{"code":"36470","type":"HCPCS"}],"standard_charges":[{"minimum":51.98,"maximum":104.62,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Endovenous rf 1st vein","code_information":[{"code":"36475","type":"HCPCS"}],"standard_charges":[{"minimum":262.77,"maximum":300.43,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":272.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":283.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1150.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2223.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1416.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1932.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3112.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1150.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4312.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6668.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":640.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6983.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2041.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2276.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":929.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1737.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1388.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1425.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1370.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":453.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Insert picvad cath","code_information":[{"code":"36571","type":"HCPCS"}],"standard_charges":[{"minimum":260.03,"maximum":260.03,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1224.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1271.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Replace cvad cath","code_information":[{"code":"36580","type":"HCPCS"}],"standard_charges":[{"minimum":71.44,"maximum":620.31,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2185.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2237.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6668.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1264.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6983.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2041.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2111.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3085.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2066.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1342.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1141.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2255.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1017.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":240.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36903","type":"HCPCS"}],"standard_charges":[{"minimum":311.52,"maximum":311.52,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":543.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":330.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":682.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":399.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":435.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":362.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove tonsils and adenoids","code_information":[{"code":"42821","type":"HCPCS"}],"standard_charges":[{"minimum":369.69,"maximum":665.23,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":373.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":545.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of tonsils","code_information":[{"code":"42825","type":"HCPCS"}],"standard_charges":[{"minimum":303.58,"maximum":703.96,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":703.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":312.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of tonsils","code_information":[{"code":"42826","type":"HCPCS"}],"standard_charges":[{"minimum":50.00,"maximum":694.66,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":694.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":329.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":348.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of adenoids","code_information":[{"code":"42830","type":"HCPCS"}],"standard_charges":[{"minimum":280.00,"maximum":611.47,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Control throat bleeding","code_information":[{"code":"42960","type":"HCPCS"}],"standard_charges":[{"minimum":25.00,"maximum":2352.76,"setting":"both","payers_information":[{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Control throat bleeding","code_information":[{"code":"42962","type":"HCPCS"}],"standard_charges":[{"minimum":437.07,"maximum":1038.91,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":625.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of esophagus pouch","code_information":[{"code":"43130","type":"HCPCS"}],"standard_charges":[{"minimum":505.33,"maximum":505.33,"setting":"both","payers_information":[{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":505.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Esophagoscopy flexible brush","code_information":[{"code":"43200","type":"HCPCS"}],"standard_charges":[{"minimum":198.89,"maximum":1313.18,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":198.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Esophagoscopy flex remove fb","code_information":[{"code":"43215","type":"HCPCS"}],"standard_charges":[{"minimum":427.01,"maximum":427.01,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":427.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Esophagoscopy balloon <30mm","code_information":[{"code":"43220","type":"HCPCS"}],"standard_charges":[{"minimum":206.36,"maximum":206.36,"setting":"both","payers_information":[{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":206.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Egd diagnostic brush wash","code_information":[{"code":"43235","type":"HCPCS"}],"standard_charges":[{"minimum":260.60,"maximum":1488.39,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":427.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":364.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":396.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":710.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":805.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":896.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":399.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":597.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":317.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":505.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":768.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":798.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":260.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1288.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":421.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":473.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":582.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":315.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":791.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":740.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":784.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1488.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Uppr gi scope w/submuc inj","code_information":[{"code":"43236","type":"HCPCS"}],"standard_charges":[{"minimum":226.45,"maximum":1316.80,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":256.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":226.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":844.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":281.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Egd biopsy single/multiple","code_information":[{"code":"43239","type":"HCPCS"}],"standard_charges":[{"minimum":257.59,"maximum":1204.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":493.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":298.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":389.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":355.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":387.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":394.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":315.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":424.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":742.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":591.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":545.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":736.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":524.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":343.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":329.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":369.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":848.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1204.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":295.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":446.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":301.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":325.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":434.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":345.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":750.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":305.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":629.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":359.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":343.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":368.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":347.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":337.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":257.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Egd tube/cath insertion","code_information":[{"code":"43241","type":"HCPCS"}],"standard_charges":[{"minimum":140.62,"maximum":1075.14,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1075.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Egd injection varices","code_information":[{"code":"43243","type":"HCPCS"}],"standard_charges":[{"minimum":2254.03,"maximum":2254.03,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2254.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Egd varices ligation","code_information":[{"code":"43244","type":"HCPCS"}],"standard_charges":[{"minimum":181.66,"maximum":1780.25,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":797.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":725.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1078.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":317.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1780.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1718.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1427.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Egd dilate stricture","code_information":[{"code":"43245","type":"HCPCS"}],"standard_charges":[{"minimum":301.46,"maximum":1283.31,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":301.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":433.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":344.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":312.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":760.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of rectum","code_information":[{"code":"45110","type":"HCPCS"}],"standard_charges":[{"minimum":2365.53,"maximum":2365.53,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":383.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Diagnostic sigmoidoscopy","code_information":[{"code":"45330","type":"HCPCS"}],"standard_charges":[{"minimum":98.75,"maximum":4581.31,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4581.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Sigmoidoscopy and biopsy","code_information":[{"code":"45331","type":"HCPCS"}],"standard_charges":[{"minimum":543.22,"maximum":1476.80,"setting":"both","payers_information":[{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1234.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Sigmoidoscopy for bleeding","code_information":[{"code":"45334","type":"HCPCS"}],"standard_charges":[{"minimum":143.64,"maximum":226.41,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":226.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Sigmoidoscopy w/submuc inj","code_information":[{"code":"45335","type":"HCPCS"}],"standard_charges":[{"minimum":200.64,"maximum":200.64,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Sigmoidoscopy w/tumr remove","code_information":[{"code":"45338","type":"HCPCS"}],"standard_charges":[{"minimum":301.77,"maximum":301.77,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":341.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Sigmoidoscopy w/plcmt stent","code_information":[{"code":"45347","type":"HCPCS"}],"standard_charges":[{"minimum":609.39,"maximum":1476.80,"setting":"both","payers_information":[{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":609.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Diagnostic colonoscopy","code_information":[{"code":"45378","type":"HCPCS"}],"standard_charges":[{"minimum":277.38,"maximum":2119.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":420.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":373.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":312.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":321.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2119.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":375.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":848.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":474.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":339.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":721.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":460.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":312.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":343.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":434.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":334.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":632.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":658.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":453.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":277.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":440.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":288.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":873.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Colonoscopy and biopsy","code_information":[{"code":"45380","type":"HCPCS"}],"standard_charges":[{"minimum":326.30,"maximum":1824.01,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":698.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":367.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":476.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":571.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":402.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":545.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1824.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":404.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":338.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1003.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":392.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":372.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":423.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":557.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":720.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":372.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":326.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":513.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":394.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":356.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":917.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Colonoscopy submucous njx","code_information":[{"code":"45381","type":"HCPCS"}],"standard_charges":[{"minimum":308.78,"maximum":648.95,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":502.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":308.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":589.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":389.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":404.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":513.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":385.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Colonoscopy w/control bleed","code_information":[{"code":"45382","type":"HCPCS"}],"standard_charges":[{"minimum":196.33,"maximum":1615.41,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1147.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":977.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":352.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":903.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45384","type":"HCPCS"}],"standard_charges":[{"minimum":351.57,"maximum":575.05,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":575.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":351.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45385","type":"HCPCS"}],"standard_charges":[{"minimum":335.18,"maximum":1824.01,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":713.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":431.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":542.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":518.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":350.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":363.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":422.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":640.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1824.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":557.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":625.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":439.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":388.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1091.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1079.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":375.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":545.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":353.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":335.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":431.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":928.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":807.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1068.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":933.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":792.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1095.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1025.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1824.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":569.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":495.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Image cath fluid colxn visc","code_information":[{"code":"49405","type":"HCPCS"}],"standard_charges":[{"minimum":197.13,"maximum":1329.61,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1196.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":605.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1329.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Image cath fluid peri/retro","code_information":[{"code":"49406","type":"HCPCS"}],"standard_charges":[{"minimum":174.44,"maximum":854.63,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":174.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":273.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":854.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":240.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":250.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Insert tun ip cath perc","code_information":[{"code":"49418","type":"HCPCS"}],"standard_charges":[{"minimum":1060.20,"maximum":1060.20,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1060.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ins tun ip cath for dial opn","code_information":[{"code":"49421","type":"HCPCS"}],"standard_charges":[{"minimum":432.31,"maximum":4294.81,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":471.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":678.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn 1st < 3 ncr/strn","code_information":[{"code":"49592","type":"HCPCS"}],"standard_charges":[{"minimum":707.89,"maximum":766.64,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1314.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":653.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn 1st 3-10 ncr/strn","code_information":[{"code":"49594","type":"HCPCS"}],"standard_charges":[{"minimum":666.34,"maximum":2892.11,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1134.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":979.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn 1st > 10 rdc","code_information":[{"code":"49595","type":"HCPCS"}],"standard_charges":[{"minimum":808.56,"maximum":2254.45,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":809.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":861.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":924.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2254.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":897.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":959.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn 1st > 10 ncr/strn","code_information":[{"code":"49596","type":"HCPCS"}],"standard_charges":[{"minimum":1018.25,"maximum":2122.26,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2122.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1037.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1425.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1373.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1196.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2018.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn rcr 3-10 rdc","code_information":[{"code":"49615","type":"HCPCS"}],"standard_charges":[{"minimum":432.07,"maximum":432.07,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn rcr 3-10 ncr/strn","code_information":[{"code":"49616","type":"HCPCS"}],"standard_charges":[{"minimum":277.86,"maximum":277.86,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":277.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rpr aa hrn rcr > 10 ncr/strn","code_information":[{"code":"49618","type":"HCPCS"}],"standard_charges":[{"minimum":773.61,"maximum":2892.11,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2892.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1437.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Lap ing hernia repair init","code_information":[{"code":"49650","type":"HCPCS"}],"standard_charges":[{"minimum":509.70,"maximum":1312.26,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":530.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":948.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":530.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1312.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":859.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Lap ing hernia repair recur","code_information":[{"code":"49651","type":"HCPCS"}],"standard_charges":[{"minimum":619.28,"maximum":1475.73,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2731.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1343.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1542.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":905.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Plmt nephroureteral catheter","code_information":[{"code":"50433","type":"HCPCS"}],"standard_charges":[{"minimum":864.09,"maximum":864.09,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":864.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Convert nephrostomy catheter","code_information":[{"code":"50434","type":"HCPCS"}],"standard_charges":[{"minimum":148.74,"maximum":622.53,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":240.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":431.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":572.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove bladder stone","code_information":[{"code":"52318","type":"HCPCS"}],"standard_charges":[{"minimum":639.38,"maximum":639.38,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":320.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52332","type":"HCPCS"}],"standard_charges":[{"minimum":40.00,"maximum":1596.71,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":679.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":324.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":413.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1596.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1352.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":692.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":243.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":641.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":458.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":696.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cystouretero & or pyeloscope","code_information":[{"code":"52351","type":"HCPCS"}],"standard_charges":[{"minimum":28.22,"maximum":803.28,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":716.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cystouretero w/stone remove","code_information":[{"code":"52352","type":"HCPCS"}],"standard_charges":[{"minimum":403.47,"maximum":1110.66,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":502.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":737.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":739.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":426.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":467.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":756.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":922.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":485.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":635.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1110.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":490.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":439.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cystouretero W/Biopsy","code_information":[{"code":"52354","type":"HCPCS"}],"standard_charges":[{"minimum":633.65,"maximum":633.65,"setting":"both","payers_information":[{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":486.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":956.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Urology surgery procedure","code_information":[{"code":"53899","type":"HCPCS"}],"standard_charges":[{"minimum":80.56,"maximum":80.56,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1532.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":570.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Total hysterectomy","code_information":[{"code":"58152","type":"HCPCS"}],"standard_charges":[{"minimum":328.64,"maximum":328.64,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Insert intrauterine device","code_information":[{"code":"58300","type":"HCPCS"}],"standard_charges":[{"minimum":36.87,"maximum":212.24,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":177.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":212.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove intrauterine device","code_information":[{"code":"58301","type":"HCPCS"}],"standard_charges":[{"minimum":29.40,"maximum":789.83,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":789.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":182.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":201.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Catheter for hysterography","code_information":[{"code":"58340","type":"HCPCS"}],"standard_charges":[{"minimum":33.02,"maximum":109.23,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58350","type":"HCPCS"}],"standard_charges":[{"minimum":1602.69,"maximum":1602.69,"setting":"both","payers_information":[{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1297.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hysteroscopy biopsy","code_information":[{"code":"58558","type":"HCPCS"}],"standard_charges":[{"minimum":219.78,"maximum":742.46,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":601.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":334.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":322.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":636.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":631.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":388.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":727.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":742.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hysteroscopy ablation","code_information":[{"code":"58563","type":"HCPCS"}],"standard_charges":[{"minimum":281.64,"maximum":1352.18,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1133.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1465.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tlh w/t/o uterus over 250 g","code_information":[{"code":"58573","type":"HCPCS"}],"standard_charges":[{"minimum":844.02,"maximum":4453.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":844.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ligate oviduct(s) add-on","code_information":[{"code":"58611","type":"HCPCS"}],"standard_charges":[{"minimum":1177.87,"maximum":3982.59,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1288.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1177.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laparoscopy lysis","code_information":[{"code":"58660","type":"HCPCS"}],"standard_charges":[{"minimum":684.06,"maximum":2254.45,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":817.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laparoscopy remove adnexa","code_information":[{"code":"58661","type":"HCPCS"}],"standard_charges":[{"minimum":209.46,"maximum":1697.60,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":938.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":922.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":564.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1256.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":755.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1697.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":949.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":892.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laparoscopy excise lesions","code_information":[{"code":"58662","type":"HCPCS"}],"standard_charges":[{"minimum":704.64,"maximum":2254.45,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":986.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1339.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1602.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2254.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":847.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laparoscopy tubal cautery","code_information":[{"code":"58670","type":"HCPCS"}],"standard_charges":[{"minimum":281.40,"maximum":856.17,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":357.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":856.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":281.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laparoscopy tubal block","code_information":[{"code":"58671","type":"HCPCS"}],"standard_charges":[{"minimum":167.20,"maximum":871.17,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":789.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":856.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":477.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Laparoscopy salpingostomy","code_information":[{"code":"58673","type":"HCPCS"}],"standard_charges":[{"minimum":298.31,"maximum":298.31,"setting":"both","payers_information":[{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":298.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Removal of ovary(s)","code_information":[{"code":"58940","type":"HCPCS"}],"standard_charges":[{"minimum":419.11,"maximum":419.11,"setting":"both","payers_information":[{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fetal non-stress test","code_information":[{"code":"59025","type":"HCPCS"}],"standard_charges":[{"minimum":27.76,"maximum":166.50,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59150","type":"HCPCS"}],"standard_charges":[{"minimum":591.61,"maximum":591.61,"setting":"both","payers_information":[{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":591.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59151","type":"HCPCS"}],"standard_charges":[{"minimum":775.50,"maximum":1232.13,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1232.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":851.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":964.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Episiotomy or vaginal repair","code_information":[{"code":"59300","type":"HCPCS"}],"standard_charges":[{"minimum":188.29,"maximum":402.95,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":402.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Obstetrical care","code_information":[{"code":"59400","type":"HCPCS"}],"standard_charges":[{"minimum":357.00,"maximum":3766.66,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3388.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":357.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2580.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2638.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3023.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2638.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2676.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2663.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2074.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3766.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3349.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Obstetrical care","code_information":[{"code":"59409","type":"HCPCS"}],"standard_charges":[{"minimum":1026.66,"maximum":1730.37,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1325.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1730.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1288.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1384.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1034.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1268.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1320.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1319.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1369.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1026.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Obstetrical care","code_information":[{"code":"59410","type":"HCPCS"}],"standard_charges":[{"minimum":350.10,"maximum":3766.66,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2886.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1325.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2488.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1338.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1278.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1250.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":350.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1238.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2794.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1250.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1345.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":924.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1512.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3766.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1278.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1049.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Deliver placenta","code_information":[{"code":"59414","type":"HCPCS"}],"standard_charges":[{"minimum":119.51,"maximum":140.85,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cesarean delivery","code_information":[{"code":"59510","type":"HCPCS"}],"standard_charges":[{"minimum":139.10,"maximum":4143.84,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1310.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3982.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3021.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1284.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2628.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4143.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2304.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3285.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1235.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1271.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1462.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2841.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1312.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1585.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2674.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3267.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1317.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1155.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cesarean delivery only","code_information":[{"code":"59514","type":"HCPCS"}],"standard_charges":[{"minimum":166.50,"maximum":2087.82,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1310.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2087.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":418.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2134.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1642.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3947.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1324.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1547.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1041.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1613.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1400.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"N block inj axillary","code_information":[{"code":"64417","type":"HCPCS"}],"standard_charges":[{"minimum":230.10,"maximum":1103.73,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":976.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":230.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":983.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1103.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"N block inj ilio-ing/hypogi","code_information":[{"code":"64425","type":"HCPCS"}],"standard_charges":[{"minimum":78.66,"maximum":78.66,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"N block inj sciatic sng","code_information":[{"code":"64445","type":"HCPCS"}],"standard_charges":[{"minimum":396.65,"maximum":3387.99,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1878.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1109.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1551.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1574.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1136.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1654.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1955.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2264.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":900.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1151.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":751.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3387.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1035.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1044.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1424.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1985.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2131.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1167.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1187.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":875.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":396.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":765.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1567.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1681.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"N block inj fem single","code_information":[{"code":"64447","type":"HCPCS"}],"standard_charges":[{"minimum":322.45,"maximum":3387.99,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1878.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1149.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1661.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1861.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":574.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1342.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":483.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1483.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1714.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2232.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2077.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":606.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":879.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1691.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1716.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1866.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1350.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1054.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3387.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1201.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1044.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1187.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2584.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1734.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1167.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1426.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1483.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":322.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":583.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1011.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1306.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"N block inj fem cont inf","code_information":[{"code":"64448","type":"HCPCS"}],"standard_charges":[{"minimum":915.34,"maximum":2324.77,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2383.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"N block stellate ganglion","code_information":[{"code":"64510","type":"HCPCS"}],"standard_charges":[{"minimum":66.49,"maximum":66.49,"setting":"both","payers_information":[{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":215.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69145","type":"HCPCS"}],"standard_charges":[{"minimum":396.66,"maximum":396.66,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69210","type":"HCPCS"}],"standard_charges":[{"minimum":16.42,"maximum":1172.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1172.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":705.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":454.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":443.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":728.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of neck","code_information":[{"code":"70360","type":"HCPCS"}],"standard_charges":[{"minimum":6.34,"maximum":1671.33,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":261.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1671.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":727.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct head/brain w/o dye","code_information":[{"code":"70450","type":"HCPCS"}],"standard_charges":[{"minimum":3.49,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":229.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":496.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":206.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":314.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":556.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":251.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":512.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":509.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1335.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":177.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":547.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1443.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":599.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":345.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":207.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":214.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":378.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":205.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":195.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":249.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":570.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":572.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":272.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":414.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":225.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":548.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":823.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct head/brain w/o & w/dye","code_information":[{"code":"70470","type":"HCPCS"}],"standard_charges":[{"minimum":40.28,"maximum":1075.73,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct orbit/ear/fossa w/dye","code_information":[{"code":"70481","type":"HCPCS"}],"standard_charges":[{"minimum":49.27,"maximum":164.28,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":164.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct orbit/ear/fossa w/o&w/dye","code_information":[{"code":"70482","type":"HCPCS"}],"standard_charges":[{"minimum":34.87,"maximum":547.53,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1027.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":205.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":155.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":245.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2882.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":727.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":346.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":715.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":285.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":453.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":298.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":459.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":258.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":717.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":735.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct angiography neck","code_information":[{"code":"70498","type":"HCPCS"}],"standard_charges":[{"minimum":146.69,"maximum":2691.32,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1493.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri orbit/face/neck w/o dye","code_information":[{"code":"70540","type":"HCPCS"}],"standard_charges":[{"minimum":58.59,"maximum":1370.80,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":195.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mr Angiography Head W/O Dye","code_information":[{"code":"70544","type":"HCPCS"}],"standard_charges":[{"minimum":97.36,"maximum":2118.20,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":655.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":368.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mr Angiography Neck W/O Dye","code_information":[{"code":"70547","type":"HCPCS"}],"standard_charges":[{"minimum":52.09,"maximum":216.56,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mr angiograph neck w/o&w/dye","code_information":[{"code":"70549","type":"HCPCS"}],"standard_charges":[{"minimum":201.02,"maximum":2143.12,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1857.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2143.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":461.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1164.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1014.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":201.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri brain stem w/o dye","code_information":[{"code":"70551","type":"HCPCS"}],"standard_charges":[{"minimum":92.11,"maximum":1265.91,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":838.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":326.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":660.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":751.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":174.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1265.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":276.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1080.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":276.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":707.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":717.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":560.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":394.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":577.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":357.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1204.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":941.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":794.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":669.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":816.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":867.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":284.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":845.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":501.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri brain stem w/dye","code_information":[{"code":"70552","type":"HCPCS"}],"standard_charges":[{"minimum":1.90,"maximum":1436.37,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":610.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1436.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri brain stem w/o & w/dye","code_information":[{"code":"70553","type":"HCPCS"}],"standard_charges":[{"minimum":62.61,"maximum":701.21,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":234.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":277.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":185.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":347.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam chest 1 view","code_information":[{"code":"71045","type":"HCPCS"}],"standard_charges":[{"minimum":24.94,"maximum":3027.61,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":223.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":654.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":322.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":584.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":525.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1366.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":176.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1824.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1182.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":370.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":655.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":636.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":851.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":630.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":891.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":651.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1072.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":267.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":309.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":443.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":818.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":798.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":464.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":843.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":298.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":652.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":243.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":250.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":675.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":653.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam chest 2 views","code_information":[{"code":"71046","type":"HCPCS"}],"standard_charges":[{"minimum":8.86,"maximum":708.22,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":708.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":525.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":636.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":198.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":500.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":228.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":488.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1947.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":178.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct thorax w/dye","code_information":[{"code":"71260","type":"HCPCS"}],"standard_charges":[{"minimum":53.08,"maximum":1706.97,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":240.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":193.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":444.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":216.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":332.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1136.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":229.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":268.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":175.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":481.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":902.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":190.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1706.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":468.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct thorax w/o & w/dye","code_information":[{"code":"71270","type":"HCPCS"}],"standard_charges":[{"minimum":56.29,"maximum":2817.94,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":180.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2817.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2185.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":168.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":180.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct thorax lung cancer scr c-","code_information":[{"code":"71271","type":"HCPCS"}],"standard_charges":[{"minimum":32.98,"maximum":105.09,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct angiography chest","code_information":[{"code":"71275","type":"HCPCS"}],"standard_charges":[{"minimum":88.57,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":517.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":382.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":611.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":286.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":649.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":402.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":803.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":304.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":273.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":785.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":604.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1102.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":493.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":556.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":283.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":444.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":355.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":266.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":320.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":470.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":384.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":368.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri chest w/o dye","code_information":[{"code":"71550","type":"HCPCS"}],"standard_charges":[{"minimum":64.42,"maximum":777.83,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":777.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri chest w/o & w/dye","code_information":[{"code":"71552","type":"HCPCS"}],"standard_charges":[{"minimum":66.16,"maximum":1178.58,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":379.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1178.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of spine 1 view","code_information":[{"code":"72020","type":"HCPCS"}],"standard_charges":[{"minimum":605.13,"maximum":3892.48,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1031.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2381.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2468.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3736.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":773.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2433.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1527.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2368.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3892.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam neck spine 2-3 vw","code_information":[{"code":"72040","type":"HCPCS"}],"standard_charges":[{"minimum":7.81,"maximum":106.09,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam neck spine 4/5vws","code_information":[{"code":"72050","type":"HCPCS"}],"standard_charges":[{"minimum":8.25,"maximum":164.14,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam thoracolmb 2/> vw","code_information":[{"code":"72080","type":"HCPCS"}],"standard_charges":[{"minimum":9.57,"maximum":590.15,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam entire spi 6/> vw","code_information":[{"code":"72084","type":"HCPCS"}],"standard_charges":[{"minimum":11.64,"maximum":37.86,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1129.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam l-2 spine 4/>vws","code_information":[{"code":"72110","type":"HCPCS"}],"standard_charges":[{"minimum":8.02,"maximum":76.32,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam l-s spine bending","code_information":[{"code":"72114","type":"HCPCS"}],"standard_charges":[{"minimum":9.32,"maximum":150.04,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray bend only l-s spine","code_information":[{"code":"72120","type":"HCPCS"}],"standard_charges":[{"minimum":10.04,"maximum":10.04,"setting":"both","payers_information":[{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct neck spine w/o dye","code_information":[{"code":"72125","type":"HCPCS"}],"standard_charges":[{"minimum":38.79,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":261.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":234.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":301.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":273.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2072.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":474.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1514.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":249.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":367.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1443.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":287.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":689.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":259.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":273.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":231.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":286.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":403.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":257.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct neck spine w/dye","code_information":[{"code":"72126","type":"HCPCS"}],"standard_charges":[{"minimum":47.71,"maximum":1029.17,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1029.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct neck spine w/o & w/dye","code_information":[{"code":"72127","type":"HCPCS"}],"standard_charges":[{"minimum":91.06,"maximum":1581.50,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":594.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1581.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct chest spine w/o dye","code_information":[{"code":"72128","type":"HCPCS"}],"standard_charges":[{"minimum":60.11,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":369.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":257.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":240.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":321.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":255.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":560.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":474.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2882.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":479.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":423.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1258.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":933.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":426.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":345.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":691.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":689.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":274.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":253.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":293.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":364.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":395.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct chest spine w/dye","code_information":[{"code":"72129","type":"HCPCS"}],"standard_charges":[{"minimum":663.69,"maximum":1029.17,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":663.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1029.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct chest spine w/o & w/dye","code_information":[{"code":"72130","type":"HCPCS"}],"standard_charges":[{"minimum":92.08,"maximum":2211.87,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":861.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2211.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":182.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":644.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1581.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct lumbar spine w/o dye","code_information":[{"code":"72131","type":"HCPCS"}],"standard_charges":[{"minimum":44.58,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":225.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":243.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":217.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":205.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":223.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":320.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":333.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2072.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":474.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1581.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":266.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1443.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":238.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":933.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":333.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":691.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":242.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1029.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct lumbar spine w/o & w/dye","code_information":[{"code":"72133","type":"HCPCS"}],"standard_charges":[{"minimum":92.08,"maximum":1160.09,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":861.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1160.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri neck spine w/o dye","code_information":[{"code":"72141","type":"HCPCS"}],"standard_charges":[{"minimum":51.36,"maximum":583.44,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":337.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":483.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":583.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":239.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri chest spine w/o dye","code_information":[{"code":"72146","type":"HCPCS"}],"standard_charges":[{"minimum":65.89,"maximum":729.92,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":228.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":285.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":335.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":186.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":296.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":296.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":335.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":483.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":729.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":375.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":194.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":544.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":246.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":473.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri chest spine w/dye","code_information":[{"code":"72147","type":"HCPCS"}],"standard_charges":[{"minimum":406.37,"maximum":406.37,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":406.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri lumbar spine w/o dye","code_information":[{"code":"72148","type":"HCPCS"}],"standard_charges":[{"minimum":50.82,"maximum":544.33,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":168.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":270.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":427.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":544.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri lumbar spine w/dye","code_information":[{"code":"72149","type":"HCPCS"}],"standard_charges":[{"minimum":406.37,"maximum":1348.76,"setting":"both","payers_information":[{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":406.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri neck spine w/o & w/dye","code_information":[{"code":"72156","type":"HCPCS"}],"standard_charges":[{"minimum":100.20,"maximum":3892.48,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":284.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":526.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":386.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":247.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":253.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":164.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":165.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":185.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":396.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":210.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri chest spine w/o & w/dye","code_information":[{"code":"72157","type":"HCPCS"}],"standard_charges":[{"minimum":104.00,"maximum":879.60,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":210.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72170","type":"HCPCS"}],"standard_charges":[{"minimum":44.64,"maximum":1962.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1182.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1102.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":195.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":220.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct pelvis w/o & w/dye","code_information":[{"code":"72194","type":"HCPCS"}],"standard_charges":[{"minimum":44.46,"maximum":1756.17,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri pelvis w/o & w/dye","code_information":[{"code":"72197","type":"HCPCS"}],"standard_charges":[{"minimum":66.66,"maximum":1494.91,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":518.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":427.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":483.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":412.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam si joints","code_information":[{"code":"72200","type":"HCPCS"}],"standard_charges":[{"minimum":7.56,"maximum":215.00,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam si joints 3/> vws","code_information":[{"code":"72202","type":"HCPCS"}],"standard_charges":[{"minimum":14.91,"maximum":392.06,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":392.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Myelography l-s spine","code_information":[{"code":"72265","type":"HCPCS"}],"standard_charges":[{"minimum":89.54,"maximum":89.54,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":353.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":289.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1035.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":514.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":231.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":244.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of shoulders","code_information":[{"code":"73050","type":"HCPCS"}],"standard_charges":[{"minimum":9.04,"maximum":53.03,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of humerus","code_information":[{"code":"73060","type":"HCPCS"}],"standard_charges":[{"minimum":7.96,"maximum":1310.81,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1310.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":689.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":708.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73070","type":"HCPCS"}],"standard_charges":[{"minimum":5.73,"maximum":701.67,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":168.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":689.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73080","type":"HCPCS"}],"standard_charges":[{"minimum":17.36,"maximum":638.50,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":850.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":207.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":559.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of arm infant","code_information":[{"code":"73092","type":"HCPCS"}],"standard_charges":[{"minimum":89.88,"maximum":356.14,"setting":"both","payers_information":[{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":356.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73100","type":"HCPCS"}],"standard_charges":[{"minimum":4.58,"maximum":141.17,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73110","type":"HCPCS"}],"standard_charges":[{"minimum":5.98,"maximum":1022.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":207.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of hand","code_information":[{"code":"73120","type":"HCPCS"}],"standard_charges":[{"minimum":11.50,"maximum":186.02,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":169.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":186.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of hand","code_information":[{"code":"73130","type":"HCPCS"}],"standard_charges":[{"minimum":5.91,"maximum":327.15,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of finger(s)","code_information":[{"code":"73140","type":"HCPCS"}],"standard_charges":[{"minimum":4.68,"maximum":983.61,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct upper extremity w/o dye","code_information":[{"code":"73200","type":"HCPCS"}],"standard_charges":[{"minimum":45.02,"maximum":3373.83,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":989.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":834.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct uppr extremity w/o&w/dye","code_information":[{"code":"73202","type":"HCPCS"}],"standard_charges":[{"minimum":77.53,"maximum":1215.49,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":270.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":366.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":495.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1215.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri Upper Extremity W/O Dye","code_information":[{"code":"73218","type":"HCPCS"}],"standard_charges":[{"minimum":38.24,"maximum":191.63,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri uppr extremity w/o&w/dye","code_information":[{"code":"73220","type":"HCPCS"}],"standard_charges":[{"minimum":65.53,"maximum":1184.32,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":691.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":256.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri joint upr extrem w/o dye","code_information":[{"code":"73221","type":"HCPCS"}],"standard_charges":[{"minimum":46.30,"maximum":179.83,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri joint upr extrem w/dye","code_information":[{"code":"73222","type":"HCPCS"}],"standard_charges":[{"minimum":74.43,"maximum":180.89,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":180.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":161.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri joint upr extr w/o&w/dye","code_information":[{"code":"73223","type":"HCPCS"}],"standard_charges":[{"minimum":65.03,"maximum":755.25,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":755.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam hip uni 1 view","code_information":[{"code":"73501","type":"HCPCS"}],"standard_charges":[{"minimum":8.46,"maximum":1935.82,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":951.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1339.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1935.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":800.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":224.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam hip uni 2-3 views","code_information":[{"code":"73502","type":"HCPCS"}],"standard_charges":[{"minimum":9.89,"maximum":804.30,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":804.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":266.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":239.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam hips bi 2 views","code_information":[{"code":"73521","type":"HCPCS"}],"standard_charges":[{"minimum":9.14,"maximum":1129.75,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1129.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":212.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of femur 2/>","code_information":[{"code":"73552","type":"HCPCS"}],"standard_charges":[{"minimum":7.65,"maximum":2882.77,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1986.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":216.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":845.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2882.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":242.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1603.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1962.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":427.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1951.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":993.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of knee 1 or 2","code_information":[{"code":"73560","type":"HCPCS"}],"standard_charges":[{"minimum":10.73,"maximum":1603.91,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1585.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":218.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1129.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1603.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":812.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of knee 3","code_information":[{"code":"73562","type":"HCPCS"}],"standard_charges":[{"minimum":6.57,"maximum":382.84,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":382.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam knee 4 or more","code_information":[{"code":"73564","type":"HCPCS"}],"standard_charges":[{"minimum":9.62,"maximum":1610.62,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1610.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of knees","code_information":[{"code":"73565","type":"HCPCS"}],"standard_charges":[{"minimum":7.25,"maximum":139.99,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of lower leg","code_information":[{"code":"73590","type":"HCPCS"}],"standard_charges":[{"minimum":4.38,"maximum":1603.91,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1603.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3387.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2000.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73610","type":"HCPCS"}],"standard_charges":[{"minimum":5.98,"maximum":103.53,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of foot","code_information":[{"code":"73620","type":"HCPCS"}],"standard_charges":[{"minimum":6.29,"maximum":2370.57,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2370.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of foot","code_information":[{"code":"73630","type":"HCPCS"}],"standard_charges":[{"minimum":7.71,"maximum":775.18,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":630.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":775.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of heel","code_information":[{"code":"73650","type":"HCPCS"}],"standard_charges":[{"minimum":30.05,"maximum":1655.14,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1655.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1339.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":257.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":345.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam of toe(s)","code_information":[{"code":"73660","type":"HCPCS"}],"standard_charges":[{"minimum":4.62,"maximum":1469.44,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":862.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1469.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct lower extremity w/o dye","code_information":[{"code":"73700","type":"HCPCS"}],"standard_charges":[{"minimum":74.77,"maximum":1986.60,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1986.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":850.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":686.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":978.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":600.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1603.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":212.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":686.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri lwr extremity w/o&w/dye","code_information":[{"code":"73720","type":"HCPCS"}],"standard_charges":[{"minimum":63.56,"maximum":1065.06,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":844.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":217.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":905.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri jnt of lwr extre w/o dye","code_information":[{"code":"73721","type":"HCPCS"}],"standard_charges":[{"minimum":42.94,"maximum":594.90,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":594.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri joint lwr extr w/o&w/dye","code_information":[{"code":"73723","type":"HCPCS"}],"standard_charges":[{"minimum":65.03,"maximum":1494.91,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":732.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":369.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1494.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":212.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam abdomen 1 view","code_information":[{"code":"74018","type":"HCPCS"}],"standard_charges":[{"minimum":6.34,"maximum":3736.52,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":281.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":168.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":926.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":332.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":256.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":744.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3736.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":851.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1640.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":513.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2381.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":714.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":542.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":818.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2250.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":603.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":521.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":334.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":599.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1062.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam abdomen 2 views","code_information":[{"code":"74019","type":"HCPCS"}],"standard_charges":[{"minimum":9.24,"maximum":1940.37,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":500.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1362.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1940.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray exam series abdomen","code_information":[{"code":"74022","type":"HCPCS"}],"standard_charges":[{"minimum":14.68,"maximum":4294.81,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2122.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":471.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":770.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":402.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1879.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":325.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4294.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1754.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1246.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":305.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct abdomen w/dye","code_information":[{"code":"74160","type":"HCPCS"}],"standard_charges":[{"minimum":49.57,"maximum":827.71,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct angio abd&pelv w/o&w/dye","code_information":[{"code":"74174","type":"HCPCS"}],"standard_charges":[{"minimum":166.89,"maximum":1538.25,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1538.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":471.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":569.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":447.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":524.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":520.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":331.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":507.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":600.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":784.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1088.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":661.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":638.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":295.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":427.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":689.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":425.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":531.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":399.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":368.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":295.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct angio abdom w/o & w/dye","code_information":[{"code":"74175","type":"HCPCS"}],"standard_charges":[{"minimum":20.00,"maximum":1243.34,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1243.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1156.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":922.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct abd & pelvis w/o contrast","code_information":[{"code":"74176","type":"HCPCS"}],"standard_charges":[{"minimum":68.35,"maximum":883.09,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":248.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":446.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":349.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":220.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":218.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":232.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":883.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":309.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":783.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":297.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":197.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":296.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":722.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":644.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":296.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":227.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":305.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct abd & pelv w/contrast","code_information":[{"code":"74177","type":"HCPCS"}],"standard_charges":[{"minimum":20.00,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":161.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":193.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":228.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":512.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":218.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":197.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":210.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1606.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":449.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":216.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":291.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":182.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":186.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":574.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":226.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":309.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct abd & pelv 1/> regns","code_information":[{"code":"74178","type":"HCPCS"}],"standard_charges":[{"minimum":55.00,"maximum":2119.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2119.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":398.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri abdomen w/o dye","code_information":[{"code":"74181","type":"HCPCS"}],"standard_charges":[{"minimum":27.46,"maximum":1455.84,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":890.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1054.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri Abdomen W/Dye","code_information":[{"code":"74182","type":"HCPCS"}],"standard_charges":[{"minimum":219.57,"maximum":220.19,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":418.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1077.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Contrast x-ray esophagus","code_information":[{"code":"74220","type":"HCPCS"}],"standard_charges":[{"minimum":20.92,"maximum":715.03,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cine/vid x-ray throat/esoph","code_information":[{"code":"74230","type":"HCPCS"}],"standard_charges":[{"minimum":20.75,"maximum":1390.33,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1390.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":305.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":394.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":215.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":932.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray upper gi delay w/o kub","code_information":[{"code":"74240","type":"HCPCS"}],"standard_charges":[{"minimum":27.65,"maximum":757.47,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74246","type":"HCPCS"}],"standard_charges":[{"minimum":28.86,"maximum":40.32,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-ray sm int f-thru std","code_information":[{"code":"74248","type":"HCPCS"}],"standard_charges":[{"minimum":47.66,"maximum":1011.39,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":570.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74270","type":"HCPCS"}],"standard_charges":[{"minimum":31.48,"maximum":976.06,"setting":"both","payers_information":[{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":172.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Card mri veloc flow mapping","code_information":[{"code":"75565","type":"HCPCS"}],"standard_charges":[{"minimum":119.81,"maximum":333.17,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct hrt w/o dye w/ca test","code_information":[{"code":"75571","type":"HCPCS"}],"standard_charges":[{"minimum":21.65,"maximum":1502.48,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1502.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ct angio hrt w/3d image","code_information":[{"code":"75574","type":"HCPCS"}],"standard_charges":[{"minimum":72.52,"maximum":254.70,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":224.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Contrast exam abdominl aorta","code_information":[{"code":"75625","type":"HCPCS"}],"standard_charges":[{"minimum":359.68,"maximum":2590.62,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2487.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":608.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":772.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":390.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam of head and neck","code_information":[{"code":"76536","type":"HCPCS"}],"standard_charges":[{"minimum":18.10,"maximum":116.22,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam chest","code_information":[{"code":"76604","type":"HCPCS"}],"standard_charges":[{"minimum":24.56,"maximum":3512.10,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1127.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":647.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":308.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":600.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":539.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1149.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":857.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":373.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ultrasound breast complete","code_information":[{"code":"76641","type":"HCPCS"}],"standard_charges":[{"minimum":22.35,"maximum":352.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":352.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":246.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ultrasound breast limited","code_information":[{"code":"76642","type":"HCPCS"}],"standard_charges":[{"minimum":27.72,"maximum":253.60,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":253.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":214.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam abdom complete","code_information":[{"code":"76700","type":"HCPCS"}],"standard_charges":[{"minimum":32.57,"maximum":1621.21,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":183.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":877.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1286.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":302.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1203.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1621.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Echo exam of abdomen","code_information":[{"code":"76705","type":"HCPCS"}],"standard_charges":[{"minimum":23.60,"maximum":3736.52,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":649.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":255.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1161.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":210.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3736.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1126.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":230.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":186.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us abdl aorta screen aaa","code_information":[{"code":"76706","type":"HCPCS"}],"standard_charges":[{"minimum":18.77,"maximum":65.10,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam abdo back wall comp","code_information":[{"code":"76770","type":"HCPCS"}],"standard_charges":[{"minimum":25.16,"maximum":1352.04,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":584.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":275.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":838.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":340.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":233.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":609.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1352.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":303.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":252.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":431.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam abdo back wall lim","code_information":[{"code":"76775","type":"HCPCS"}],"standard_charges":[{"minimum":15.94,"maximum":1061.66,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":200.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":337.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":855.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1061.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam k transpl w/doppler","code_information":[{"code":"76776","type":"HCPCS"}],"standard_charges":[{"minimum":906.08,"maximum":906.08,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":906.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam spinal canal","code_information":[{"code":"76800","type":"HCPCS"}],"standard_charges":[{"minimum":48.51,"maximum":531.66,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":531.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ob us < 14 wks single fetus","code_information":[{"code":"76801","type":"HCPCS"}],"standard_charges":[{"minimum":28.09,"maximum":89.95,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ob us < 14 wks addl fetus","code_information":[{"code":"76802","type":"HCPCS"}],"standard_charges":[{"minimum":110.11,"maximum":118.49,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ob us >/= 14 wks sngl fetus","code_information":[{"code":"76805","type":"HCPCS"}],"standard_charges":[{"minimum":39.30,"maximum":202.59,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ob us >/= 14 wks addl fetus","code_information":[{"code":"76810","type":"HCPCS"}],"standard_charges":[{"minimum":68.01,"maximum":184.31,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":184.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ob us limited fetus(s)","code_information":[{"code":"76815","type":"HCPCS"}],"standard_charges":[{"minimum":22.67,"maximum":167.94,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ob us follow-up per fetus","code_information":[{"code":"76816","type":"HCPCS"}],"standard_charges":[{"minimum":20.01,"maximum":138.82,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Transvaginal us obstetric","code_information":[{"code":"76817","type":"HCPCS"}],"standard_charges":[{"minimum":26.16,"maximum":141.25,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fetal biophys profile w/nst","code_information":[{"code":"76818","type":"HCPCS"}],"standard_charges":[{"minimum":47.39,"maximum":128.90,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fetal biophys profil w/o nst","code_information":[{"code":"76819","type":"HCPCS"}],"standard_charges":[{"minimum":64.66,"maximum":237.40,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":237.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Umbilical artery echo","code_information":[{"code":"76820","type":"HCPCS"}],"standard_charges":[{"minimum":62.30,"maximum":176.44,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":176.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Middle cerebral artery echo","code_information":[{"code":"76821","type":"HCPCS"}],"standard_charges":[{"minimum":139.20,"maximum":139.20,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Transvaginal us non-ob","code_information":[{"code":"76830","type":"HCPCS"}],"standard_charges":[{"minimum":30.05,"maximum":168.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":331.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":302.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":215.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us transrectal","code_information":[{"code":"76872","type":"HCPCS"}],"standard_charges":[{"minimum":101.88,"maximum":441.75,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us xtr non-vasc complete","code_information":[{"code":"76881","type":"HCPCS"}],"standard_charges":[{"minimum":24.64,"maximum":763.30,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us xtr non-vasc lmtd","code_information":[{"code":"76882","type":"HCPCS"}],"standard_charges":[{"minimum":17.51,"maximum":1217.91,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1217.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":713.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Us exam infant hips static","code_information":[{"code":"76886","type":"HCPCS"}],"standard_charges":[{"minimum":25.80,"maximum":377.96,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mri breast c- bilateral","code_information":[{"code":"77047","type":"HCPCS"}],"standard_charges":[{"minimum":63.22,"maximum":63.22,"setting":"both","payers_information":[{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77062","type":"HCPCS"}],"standard_charges":[{"minimum":30.99,"maximum":352.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":352.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":246.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77063","type":"HCPCS"}],"standard_charges":[{"minimum":53.92,"maximum":60.18,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"77065","type":"HCPCS"}],"standard_charges":[{"minimum":31.41,"maximum":718.20,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":207.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":718.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"77066","type":"HCPCS"}],"standard_charges":[{"minimum":48.61,"maximum":283.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":283.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":246.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"77067","type":"HCPCS"}],"standard_charges":[{"minimum":20.93,"maximum":428.38,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":428.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"X-Ray Stress View","code_information":[{"code":"77071","type":"HCPCS"}],"standard_charges":[{"minimum":1490.95,"maximum":1490.95,"setting":"both","payers_information":[{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":465.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Radiation therapy dose plan","code_information":[{"code":"77300","type":"HCPCS"}],"standard_charges":[{"minimum":93.43,"maximum":1236.34,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":490.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":553.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Telethx isodose plan cplx","code_information":[{"code":"77307","type":"HCPCS"}],"standard_charges":[{"minimum":152.66,"maximum":1573.52,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":381.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":460.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":386.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1573.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Special teletx port plan","code_information":[{"code":"77321","type":"HCPCS"}],"standard_charges":[{"minimum":85.03,"maximum":623.85,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":557.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":234.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":278.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":271.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78014","type":"HCPCS"}],"standard_charges":[{"minimum":15.47,"maximum":53.22,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Parathyroid planar imaging","code_information":[{"code":"78070","type":"HCPCS"}],"standard_charges":[{"minimum":22.11,"maximum":54.86,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hepatobiliary system imaging","code_information":[{"code":"78226","type":"HCPCS"}],"standard_charges":[{"minimum":30.56,"maximum":1293.48,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":287.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":390.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":609.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1286.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1165.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":592.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":360.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1293.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hepatobil syst image w/drug","code_information":[{"code":"78227","type":"HCPCS"}],"standard_charges":[{"minimum":28.03,"maximum":482.83,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":214.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":482.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ht muscle image spect sing","code_information":[{"code":"78451","type":"HCPCS"}],"standard_charges":[{"minimum":100.57,"maximum":452.29,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":697.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Brain image w/flow < 4 views","code_information":[{"code":"78601","type":"HCPCS"}],"standard_charges":[{"minimum":1042.34,"maximum":2231.27,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tumor imaging limited area","code_information":[{"code":"78800","type":"HCPCS"}],"standard_charges":[{"minimum":19.75,"maximum":1150.28,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1034.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1150.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Pet image w/ct skull-thigh","code_information":[{"code":"78815","type":"HCPCS"}],"standard_charges":[{"minimum":72.44,"maximum":274.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":164.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Psych diag eval w/med srvcs","code_information":[{"code":"90792","type":"HCPCS"}],"standard_charges":[{"minimum":105.30,"maximum":111.62,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Psytx w pt 30 minutes","code_information":[{"code":"90832","type":"HCPCS"}],"standard_charges":[{"minimum":23.96,"maximum":50.25,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Psytx w pt w e/m 30 min","code_information":[{"code":"90833","type":"HCPCS"}],"standard_charges":[{"minimum":38.09,"maximum":144.49,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":656.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":779.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hemodialysis repeated eval","code_information":[{"code":"90937","type":"HCPCS"}],"standard_charges":[{"minimum":803.29,"maximum":803.29,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":803.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Dialysis one evaluation","code_information":[{"code":"90945","type":"HCPCS"}],"standard_charges":[{"minimum":74.08,"maximum":1515.56,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1515.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Esrd srv 4 visits p mo 20+","code_information":[{"code":"90960","type":"HCPCS"}],"standard_charges":[{"minimum":1533.30,"maximum":1533.30,"setting":"both","payers_information":[{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":215.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Eye exam new patient","code_information":[{"code":"92004","type":"HCPCS"}],"standard_charges":[{"minimum":5.64,"maximum":175.16,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":175.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Eye exam establish patient","code_information":[{"code":"92012","type":"HCPCS"}],"standard_charges":[{"minimum":7.38,"maximum":110.76,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Eye exam&tx estab pt 1/>vst","code_information":[{"code":"92014","type":"HCPCS"}],"standard_charges":[{"minimum":47.61,"maximum":154.61,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Determine refractive state","code_information":[{"code":"92015","type":"HCPCS"}],"standard_charges":[{"minimum":32.59,"maximum":317.11,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":317.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Special eye evaluation","code_information":[{"code":"92020","type":"HCPCS"}],"standard_charges":[{"minimum":47.24,"maximum":142.68,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Special eye evaluation","code_information":[{"code":"92060","type":"HCPCS"}],"standard_charges":[{"minimum":174.46,"maximum":174.46,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Visual field examination(s)","code_information":[{"code":"92083","type":"HCPCS"}],"standard_charges":[{"minimum":18.08,"maximum":137.49,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cmptr ophth dx img ant segmt","code_information":[{"code":"92132","type":"HCPCS"}],"standard_charges":[{"minimum":18.40,"maximum":49.56,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cmptr ophth img optic nerve","code_information":[{"code":"92133","type":"HCPCS"}],"standard_charges":[{"minimum":46.40,"maximum":184.67,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cptr ophth dx img post segmt","code_information":[{"code":"92134","type":"HCPCS"}],"standard_charges":[{"minimum":23.17,"maximum":159.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ophthalmic biometry","code_information":[{"code":"92136","type":"HCPCS"}],"standard_charges":[{"minimum":5.64,"maximum":217.74,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":169.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":217.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fluorescein angrph uni/bi","code_information":[{"code":"92235","type":"HCPCS"}],"standard_charges":[{"minimum":92.93,"maximum":92.93,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Basic vestibular evaluation","code_information":[{"code":"92540","type":"HCPCS"}],"standard_charges":[{"minimum":111.81,"maximum":320.96,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Pure tone hearing test air","code_information":[{"code":"92551","type":"HCPCS"}],"standard_charges":[{"minimum":72.74,"maximum":72.74,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":174.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Evoked auditory test qual","code_information":[{"code":"92558","type":"HCPCS"}],"standard_charges":[{"minimum":13.55,"maximum":86.06,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tympanometry","code_information":[{"code":"92567","type":"HCPCS"}],"standard_charges":[{"minimum":13.03,"maximum":174.64,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Visual audiometry (vra)","code_information":[{"code":"92579","type":"HCPCS"}],"standard_charges":[{"minimum":20.61,"maximum":20.61,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Electrocochleography","code_information":[{"code":"92584","type":"HCPCS"}],"standard_charges":[{"minimum":95.31,"maximum":320.96,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":320.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Evoked auditory tst complete","code_information":[{"code":"92588","type":"HCPCS"}],"standard_charges":[{"minimum":13.03,"maximum":95.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hearing aid exam one ear","code_information":[{"code":"92590","type":"HCPCS"}],"standard_charges":[{"minimum":74.00,"maximum":74.00,"setting":"both","payers_information":[{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hearing aid exam both ears","code_information":[{"code":"92591","type":"HCPCS"}],"standard_charges":[{"minimum":64.82,"maximum":116.70,"setting":"both","payers_information":[{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prq cardiac angioplast 1 art","code_information":[{"code":"92920","type":"HCPCS"}],"standard_charges":[{"minimum":567.17,"maximum":4408.17,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1003.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":724.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1279.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prq card stent w/angio 1 vsl","code_information":[{"code":"92928","type":"HCPCS"}],"standard_charges":[{"minimum":66.70,"maximum":2402.63,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1130.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":644.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1174.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":330.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1269.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1085.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":989.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2268.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1011.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1433.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":933.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1880.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":425.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prq revasc byp graft 1 vsl","code_information":[{"code":"92937","type":"HCPCS"}],"standard_charges":[{"minimum":739.09,"maximum":1490.35,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1350.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":998.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prq card revasc mi 1 vsl","code_information":[{"code":"92941","type":"HCPCS"}],"standard_charges":[{"minimum":152.58,"maximum":2646.42,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1440.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1233.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1010.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2646.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2380.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1050.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1234.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2316.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":473.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":218.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1102.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":435.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":333.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":300.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":836.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":182.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":243.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":308.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93015","type":"HCPCS"}],"standard_charges":[{"minimum":102.55,"maximum":102.55,"setting":"both","payers_information":[{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93016","type":"HCPCS"}],"standard_charges":[{"minimum":17.72,"maximum":593.40,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":182.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":479.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":144.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":436.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":461.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":296.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":445.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":210.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":379.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":161.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":593.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":401.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93018","type":"HCPCS"}],"standard_charges":[{"minimum":76.48,"maximum":701.21,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":172.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":161.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":348.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":461.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":493.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":410.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":253.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":204.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":633.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93227","type":"HCPCS"}],"standard_charges":[{"minimum":12.95,"maximum":78.19,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":14.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Remote 30 day ecg rev/report","code_information":[{"code":"93228","type":"HCPCS"}],"standard_charges":[{"minimum":18.19,"maximum":23.86,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ext ecg>48hr<7d rev&interpj","code_information":[{"code":"93244","type":"HCPCS"}],"standard_charges":[{"minimum":19.02,"maximum":182.97,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Pm device progr eval dual","code_information":[{"code":"93280","type":"HCPCS"}],"standard_charges":[{"minimum":25.84,"maximum":739.05,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prgrmg eval implantable dfb","code_information":[{"code":"93282","type":"HCPCS"}],"standard_charges":[{"minimum":29.73,"maximum":823.65,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prgrmg eval implantable dfb","code_information":[{"code":"93283","type":"HCPCS"}],"standard_charges":[{"minimum":39.86,"maximum":118.16,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Dev interrog remote 1/2/mlt","code_information":[{"code":"93295","type":"HCPCS"}],"standard_charges":[{"minimum":26.16,"maximum":89.46,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ilr device interrogat remote","code_information":[{"code":"93298","type":"HCPCS"}],"standard_charges":[{"minimum":11.11,"maximum":54.83,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tte w/doppler complete","code_information":[{"code":"93306","type":"HCPCS"}],"standard_charges":[{"minimum":50.13,"maximum":1136.65,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":793.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":262.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":250.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":233.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1136.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":614.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":216.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1085.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":596.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":429.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":559.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":269.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tte f-up or lmtd","code_information":[{"code":"93308","type":"HCPCS"}],"standard_charges":[{"minimum":29.77,"maximum":6983.53,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":624.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":585.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":432.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":555.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1989.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":866.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2432.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":245.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6983.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":309.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":860.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":714.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":384.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1130.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1150.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":536.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":279.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":763.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":598.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":558.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":213.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":480.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":449.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":374.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":649.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":677.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Echo transesophageal","code_information":[{"code":"93312","type":"HCPCS"}],"standard_charges":[{"minimum":233.84,"maximum":6668.24,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2720.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1621.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Doppler echo exam heart","code_information":[{"code":"93320","type":"HCPCS"}],"standard_charges":[{"minimum":195.15,"maximum":2720.53,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1186.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":308.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":149.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":569.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1989.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":866.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2432.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":245.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6983.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":962.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":384.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":220.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Doppler color flow add-on","code_information":[{"code":"93325","type":"HCPCS"}],"standard_charges":[{"minimum":48.10,"maximum":2720.53,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":597.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":736.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":619.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1621.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Stress tte only","code_information":[{"code":"93350","type":"HCPCS"}],"standard_charges":[{"minimum":52.39,"maximum":921.69,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Echo transesophageal (tee)","code_information":[{"code":"93355","type":"HCPCS"}],"standard_charges":[{"minimum":1151.48,"maximum":1446.71,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1255.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1222.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1226.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Right heart cath","code_information":[{"code":"93451","type":"HCPCS"}],"standard_charges":[{"minimum":117.48,"maximum":1913.51,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":312.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1085.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1199.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":866.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":912.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Coronary art/grft angio s&i","code_information":[{"code":"93455","type":"HCPCS"}],"standard_charges":[{"minimum":269.24,"maximum":6459.54,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":737.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":963.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6459.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":624.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":788.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":758.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1604.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"R hrt coronary artery angio","code_information":[{"code":"93456","type":"HCPCS"}],"standard_charges":[{"minimum":205.25,"maximum":3313.71,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":205.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":290.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3313.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"L hrt artery/ventricle angio","code_information":[{"code":"93458","type":"HCPCS"}],"standard_charges":[{"minimum":198.41,"maximum":6668.24,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":280.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":483.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":720.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":401.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2672.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6668.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":488.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":895.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":794.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1736.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1623.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":540.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":987.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2316.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":899.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":498.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":706.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":198.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"L hrt art/grft angio","code_information":[{"code":"93459","type":"HCPCS"}],"standard_charges":[{"minimum":408.27,"maximum":2176.36,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":813.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2176.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1512.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":823.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1082.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1334.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":580.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1000.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1055.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93460","type":"HCPCS"}],"standard_charges":[{"minimum":362.36,"maximum":1796.44,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1730.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":373.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1398.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1085.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":387.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":362.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1409.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":853.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":927.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1796.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1694.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":779.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":454.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":995.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":750.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93461","type":"HCPCS"}],"standard_charges":[{"minimum":479.01,"maximum":2055.60,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2055.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1243.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":479.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Inject suprvlv aortography","code_information":[{"code":"93567","type":"HCPCS"}],"standard_charges":[{"minimum":280.10,"maximum":1104.02,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":280.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":634.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":479.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1104.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1353.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1260.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":965.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1400.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1396.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":509.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ep & ablate ventric tachy","code_information":[{"code":"93654","type":"HCPCS"}],"standard_charges":[{"minimum":721.74,"maximum":2404.29,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1511.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1129.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tx l/r atrial fib addl","code_information":[{"code":"93657","type":"HCPCS"}],"standard_charges":[{"minimum":2154.59,"maximum":2154.59,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1354.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Anticoag mgmt pt warfarin","code_information":[{"code":"93793","type":"HCPCS"}],"standard_charges":[{"minimum":7.02,"maximum":73.47,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Cardiovascular procedure","code_information":[{"code":"93799","type":"HCPCS"}],"standard_charges":[{"minimum":11.34,"maximum":1232.19,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":721.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1232.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Extracranial bilat study","code_information":[{"code":"93880","type":"HCPCS"}],"standard_charges":[{"minimum":11.18,"maximum":2118.20,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":234.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":205.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2118.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":722.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":929.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Upr/l xtremity art 2 levels","code_information":[{"code":"93922","type":"HCPCS"}],"standard_charges":[{"minimum":8.68,"maximum":1161.49,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":237.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1161.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":574.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Upr/lxtr art stdy 3+ lvls","code_information":[{"code":"93923","type":"HCPCS"}],"standard_charges":[{"minimum":20.19,"maximum":121.99,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Lwr xtr vasc stdy bilat","code_information":[{"code":"93924","type":"HCPCS"}],"standard_charges":[{"minimum":18.95,"maximum":34.33,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Lower extremity study","code_information":[{"code":"93925","type":"HCPCS"}],"standard_charges":[{"minimum":30.16,"maximum":4179.96,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1334.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1161.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":536.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":476.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1232.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":659.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Lower extremity study","code_information":[{"code":"93926","type":"HCPCS"}],"standard_charges":[{"minimum":21.60,"maximum":2424.46,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":143.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":497.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1970.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1703.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":586.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Extremity study","code_information":[{"code":"93970","type":"HCPCS"}],"standard_charges":[{"minimum":30.40,"maximum":2434.84,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":629.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":698.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":396.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":564.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":367.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":549.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1129.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":599.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1640.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":337.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":568.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":366.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":570.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":329.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":405.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":214.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Extremity study","code_information":[{"code":"93971","type":"HCPCS"}],"standard_charges":[{"minimum":16.80,"maximum":1241.22,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":268.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":213.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":368.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":194.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":556.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":165.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Vascular study","code_information":[{"code":"93975","type":"HCPCS"}],"standard_charges":[{"minimum":46.86,"maximum":1546.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1546.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":479.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":547.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":253.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Vascular study","code_information":[{"code":"93976","type":"HCPCS"}],"standard_charges":[{"minimum":27.07,"maximum":1918.82,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":600.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1918.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":349.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":936.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":973.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":243.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1824.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":407.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":292.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1606.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":964.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1817.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":681.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":294.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1479.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Vascular study","code_information":[{"code":"93978","type":"HCPCS"}],"standard_charges":[{"minimum":27.90,"maximum":99.84,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Dup-scan hemo compl uni std","code_information":[{"code":"93986","type":"HCPCS"}],"standard_charges":[{"minimum":19.94,"maximum":1304.27,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1144.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Breathing capacity test","code_information":[{"code":"94010","type":"HCPCS"}],"standard_charges":[{"minimum":9.27,"maximum":3241.95,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1494.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3241.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":196.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94060","type":"HCPCS"}],"standard_charges":[{"minimum":14.57,"maximum":93.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Pulmonary stress testing","code_information":[{"code":"94618","type":"HCPCS"}],"standard_charges":[{"minimum":62.76,"maximum":399.11,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Pulm funct tst plethysmograp","code_information":[{"code":"94726","type":"HCPCS"}],"standard_charges":[{"minimum":21.92,"maximum":147.20,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Co/membane diffuse capacity","code_information":[{"code":"94729","type":"HCPCS"}],"standard_charges":[{"minimum":21.92,"maximum":147.20,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":37.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Percut allergy skin tests","code_information":[{"code":"95004","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":795.36,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":370.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":420.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":231.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":363.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Icut allergy test drug/bug","code_information":[{"code":"95024","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":795.36,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":428.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":238.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":363.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Immunotherapy one injection","code_information":[{"code":"95115","type":"HCPCS"}],"standard_charges":[{"minimum":7.55,"maximum":7.91,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Antigen therapy services","code_information":[{"code":"95165","type":"HCPCS"}],"standard_charges":[{"minimum":7.15,"maximum":26.20,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Allergy immunology services","code_information":[{"code":"95199","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":10.00,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Gluc monitor cont phys i&r","code_information":[{"code":"95251","type":"HCPCS"}],"standard_charges":[{"minimum":46.49,"maximum":192.05,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":175.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Multiple sleep latency test","code_information":[{"code":"95805","type":"HCPCS"}],"standard_charges":[{"minimum":46.27,"maximum":52.07,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":145.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":190.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":165.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Polysom 6/>yrs cpap 4/> parm","code_information":[{"code":"95811","type":"HCPCS"}],"standard_charges":[{"minimum":57.98,"maximum":225.52,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":169.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":185.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":164.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Eeg awake and drowsy","code_information":[{"code":"95816","type":"HCPCS"}],"standard_charges":[{"minimum":41.27,"maximum":601.91,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":335.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Eeg awake and asleep","code_information":[{"code":"95819","type":"HCPCS"}],"standard_charges":[{"minimum":43.75,"maximum":1250.26,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1000.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":885.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1101.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1250.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1084.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":206.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":765.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Eeg coma or sleep only","code_information":[{"code":"95822","type":"HCPCS"}],"standard_charges":[{"minimum":62.22,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1544.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2240.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2231.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3583.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1690.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1049.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1272.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1072.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Nrv cndj test 7-8 studies","code_information":[{"code":"95910","type":"HCPCS"}],"standard_charges":[{"minimum":79.53,"maximum":164.35,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Nrv cndj test 9-10 studies","code_information":[{"code":"95911","type":"HCPCS"}],"standard_charges":[{"minimum":105.37,"maximum":179.87,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Nrv cndj test 11-12 studies","code_information":[{"code":"95912","type":"HCPCS"}],"standard_charges":[{"minimum":126.68,"maximum":330.63,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":182.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Nrv cndj test 13/> studies","code_information":[{"code":"95913","type":"HCPCS"}],"standard_charges":[{"minimum":150.02,"maximum":241.14,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":237.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Analyze neurostim no prog","code_information":[{"code":"95970","type":"HCPCS"}],"standard_charges":[{"minimum":60.78,"maximum":129.70,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Alys smpl cn npgt prgrmg","code_information":[{"code":"95976","type":"HCPCS"}],"standard_charges":[{"minimum":54.45,"maximum":152.01,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Canalith repositioning proc","code_information":[{"code":"95992","type":"HCPCS"}],"standard_charges":[{"minimum":47.88,"maximum":229.84,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":229.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Developmental screen w/score","code_information":[{"code":"96110","type":"HCPCS"}],"standard_charges":[{"minimum":25.68,"maximum":138.60,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Devel tst phys/qhp 1st hr","code_information":[{"code":"96112","type":"HCPCS"}],"standard_charges":[{"minimum":152.86,"maximum":191.70,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Devel tst phys/qhp ea addl","code_information":[{"code":"96113","type":"HCPCS"}],"standard_charges":[{"minimum":152.86,"maximum":191.70,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":191.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":179.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":154.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":171.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Pt-focused hlth risk assmt","code_information":[{"code":"96160","type":"HCPCS"}],"standard_charges":[{"minimum":65.70,"maximum":65.70,"setting":"both","payers_information":[{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Bhv id assmt by phys/qhp","code_information":[{"code":"97151","type":"HCPCS"}],"standard_charges":[{"minimum":223.52,"maximum":509.13,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":351.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":370.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":365.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":286.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":509.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":326.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":354.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":381.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":223.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":416.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":254.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":329.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Adaptive behavior tx by tech","code_information":[{"code":"97153","type":"HCPCS"}],"standard_charges":[{"minimum":202.50,"maximum":301.14,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":224.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":211.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":211.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":241.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":280.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":211.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Adapt behavior tx phys/qhp","code_information":[{"code":"97155","type":"HCPCS"}],"standard_charges":[{"minimum":322.79,"maximum":517.46,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":379.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":339.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":360.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":369.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":517.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":510.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":368.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":365.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":365.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Fam adapt bhv tx gdn phy/qhp","code_information":[{"code":"97156","type":"HCPCS"}],"standard_charges":[{"minimum":197.45,"maximum":482.25,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":441.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":331.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":431.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":305.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":374.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":409.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":414.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":262.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":277.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":254.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":326.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Rmvl devital tis 20 cm/<","code_information":[{"code":"97597","type":"HCPCS"}],"standard_charges":[{"minimum":28.55,"maximum":1044.79,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":223.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1044.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97608","type":"HCPCS"}],"standard_charges":[{"minimum":1612.05,"maximum":1612.05,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Osteopath manj 3-4 regions","code_information":[{"code":"98926","type":"HCPCS"}],"standard_charges":[{"minimum":20.20,"maximum":106.09,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Osteopath manj 5-6 regions","code_information":[{"code":"98927","type":"HCPCS"}],"standard_charges":[{"minimum":26.85,"maximum":107.92,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Osteopath manj 7-8 regions","code_information":[{"code":"98928","type":"HCPCS"}],"standard_charges":[{"minimum":33.86,"maximum":77.76,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Postop follow-up visit","code_information":[{"code":"99024","type":"HCPCS"}],"standard_charges":[{"minimum":7.37,"maximum":3736.52,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":693.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":514.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":480.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":450.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":333.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1243.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":216.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1002.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":433.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":490.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3736.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":925.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":630.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3085.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1603.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2866.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1044.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":474.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":639.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":482.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2835.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":960.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":536.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":375.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":334.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":9.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1556.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":349.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":608.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Special anesthesia service","code_information":[{"code":"99100","type":"HCPCS"}],"standard_charges":[{"minimum":276.36,"maximum":3027.61,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2588.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":824.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":757.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":538.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":829.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1220.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":317.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1204.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":276.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":633.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":505.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1084.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":399.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2250.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":773.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":885.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":728.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":291.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":847.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Emergency anesthesia","code_information":[{"code":"99140","type":"HCPCS"}],"standard_charges":[{"minimum":181.66,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1397.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":844.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":847.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":732.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":910.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2196.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1514.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":181.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3497.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":937.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2771.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":739.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1443.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3736.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1352.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":246.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1646.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3558.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":550.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":590.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":875.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":720.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3373.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":899.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1617.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1632.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":929.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":692.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2208.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1358.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1474.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":692.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mod sed same phys/qhp <5 yrs","code_information":[{"code":"99151","type":"HCPCS"}],"standard_charges":[{"minimum":138.03,"maximum":829.51,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":829.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mod sed same phys/qhp 5/>yrs","code_information":[{"code":"99152","type":"HCPCS"}],"standard_charges":[{"minimum":119.91,"maximum":3806.22,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1730.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":429.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":448.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":296.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":400.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":290.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":529.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":360.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":224.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1059.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1409.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":433.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":330.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":549.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":513.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":260.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":169.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1085.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3387.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":726.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":526.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3806.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2835.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":819.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":827.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":488.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":634.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":479.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":198.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":617.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":734.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":218.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mod sed same phys/qhp ea","code_information":[{"code":"99153","type":"HCPCS"}],"standard_charges":[{"minimum":112.12,"maximum":1011.85,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":206.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":692.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":157.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":206.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":172.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1011.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":314.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Mod sed oth phys/qhp 5/>yrs","code_information":[{"code":"99156","type":"HCPCS"}],"standard_charges":[{"minimum":431.85,"maximum":693.24,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":431.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":693.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hyperbaric oxygen therapy","code_information":[{"code":"99183","type":"HCPCS"}],"standard_charges":[{"minimum":68.14,"maximum":92.33,"setting":"both","payers_information":[{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99202","type":"HCPCS"}],"standard_charges":[{"minimum":13.03,"maximum":97.20,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":13.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99203","type":"HCPCS"}],"standard_charges":[{"minimum":42.11,"maximum":208.52,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":208.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99204","type":"HCPCS"}],"standard_charges":[{"minimum":5.91,"maximum":209.84,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":193.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":193.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":125.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit new","code_information":[{"code":"99205","type":"HCPCS"}],"standard_charges":[{"minimum":33.06,"maximum":2119.80,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1549.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":531.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":500.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":148.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":169.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2119.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":172.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":193.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":232.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":161.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":211.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":168.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99211","type":"HCPCS"}],"standard_charges":[{"minimum":6.15,"maximum":126.40,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":7.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":6.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99212","type":"HCPCS"}],"standard_charges":[{"minimum":8.34,"maximum":57.62,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":19.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":33.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":15.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":20.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":16.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99213","type":"HCPCS"}],"standard_charges":[{"minimum":17.60,"maximum":150.01,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":34.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":18.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":42.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99214","type":"HCPCS"}],"standard_charges":[{"minimum":41.87,"maximum":146.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":146.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":84.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Office/outpatient visit est","code_information":[{"code":"99215","type":"HCPCS"}],"standard_charges":[{"minimum":87.17,"maximum":281.54,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":183.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":173.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":281.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":121.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Initial hospital care","code_information":[{"code":"99221","type":"HCPCS"}],"standard_charges":[{"minimum":131.47,"maximum":2291.91,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":490.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":423.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":702.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":632.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":399.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":376.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":949.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1989.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1161.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2291.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":331.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":991.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1494.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":911.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1527.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1044.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":890.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":372.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":720.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":635.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":836.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1022.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1030.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":808.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1638.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":366.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":802.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":668.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":754.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":537.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":946.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":374.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Initial hospital care","code_information":[{"code":"99222","type":"HCPCS"}],"standard_charges":[{"minimum":282.12,"maximum":2691.32,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1027.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":548.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":781.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":511.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1585.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":400.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":530.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":751.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":465.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1345.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":509.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":865.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":709.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":785.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":373.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":541.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":823.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1443.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":599.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":640.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":628.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1065.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":481.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":833.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":770.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":553.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":683.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2691.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":650.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":819.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":916.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":364.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":522.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":819.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":737.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":660.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":374.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":318.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":499.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":778.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":739.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Initial hospital care","code_information":[{"code":"99223","type":"HCPCS"}],"standard_charges":[{"minimum":60.11,"maximum":2822.44,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":699.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":659.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1144.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":614.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":622.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1052.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":632.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":541.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1169.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":950.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1440.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":392.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":869.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":594.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1009.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2405.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":740.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":899.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":701.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":596.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2822.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1148.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1053.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":763.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":684.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2691.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":798.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1409.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1533.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":304.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":529.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1006.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1556.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":921.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":744.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1021.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":912.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Subsequent hospital care","code_information":[{"code":"99231","type":"HCPCS"}],"standard_charges":[{"minimum":23.33,"maximum":4081.83,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":424.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1039.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":879.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":377.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":483.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":582.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":778.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1228.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":742.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1161.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1335.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":594.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":826.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":689.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":746.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":636.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":737.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":679.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":661.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":611.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":926.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":625.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":219.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":559.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1204.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4081.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":893.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":664.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":708.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":907.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":453.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":621.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":744.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":626.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":855.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Subsequent hospital care","code_information":[{"code":"99232","type":"HCPCS"}],"standard_charges":[{"minimum":115.24,"maximum":3085.44,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1329.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":659.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":772.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":393.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":632.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":531.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":582.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":702.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":590.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":688.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1345.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":584.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1174.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":709.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":816.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":331.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":545.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":811.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":683.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":552.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":640.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3085.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":463.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":591.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":792.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":655.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":549.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":720.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":485.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":836.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2183.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1159.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":647.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":717.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":573.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":840.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":639.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1556.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":464.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":567.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":688.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Subsequent hospital care","code_information":[{"code":"99233","type":"HCPCS"}],"standard_charges":[{"minimum":282.12,"maximum":4081.83,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1649.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":815.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1303.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3027.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":592.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":713.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1148.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":555.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":469.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1148.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":307.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":640.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1975.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1079.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1143.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":749.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":899.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":830.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":677.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2866.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":708.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1084.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1093.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":630.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":757.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":836.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4081.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1504.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1601.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":677.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":708.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1122.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":660.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1135.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":711.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1167.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":629.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Observ/hosp same date","code_information":[{"code":"99234","type":"HCPCS"}],"standard_charges":[{"minimum":11.18,"maximum":2143.64,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":955.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":576.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":264.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":437.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":653.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":519.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":17.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2143.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1125.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1775.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":379.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":997.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1611.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1621.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Observ/hosp same date","code_information":[{"code":"99235","type":"HCPCS"}],"standard_charges":[{"minimum":133.69,"maximum":1715.64,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1106.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":452.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":310.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":250.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":438.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":389.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":547.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1637.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1443.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1715.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1002.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":440.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":345.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1225.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":560.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":502.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":253.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":281.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":740.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":218.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":365.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":374.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":239.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":536.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":359.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Observ/hosp same date","code_information":[{"code":"99236","type":"HCPCS"}],"standard_charges":[{"minimum":348.01,"maximum":3593.49,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":418.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1301.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":348.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3593.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":707.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":410.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":737.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":598.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hospital discharge day","code_information":[{"code":"99238","type":"HCPCS"}],"standard_charges":[{"minimum":23.33,"maximum":2691.32,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":255.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":222.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":480.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":243.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":301.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":659.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":455.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":863.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":677.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":552.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":567.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":831.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1606.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":975.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":23.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":273.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":247.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":534.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":224.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2691.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":798.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":361.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":410.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":350.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":585.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":228.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":187.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":558.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":203.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hospital discharge day","code_information":[{"code":"99239","type":"HCPCS"}],"standard_charges":[{"minimum":48.98,"maximum":2866.19,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":450.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":382.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":511.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":393.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":632.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":331.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":330.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":521.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":395.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":534.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":787.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":376.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":836.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Eastern Kentucky Correctional Complex","plan_name":"Eastern Kentucky Correctional Complex","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":453.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":513.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":339.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":323.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":539.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":441.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":343.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":770.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":556.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":469.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2866.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":206.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":737.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1088.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1110.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":641.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1536.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Inpatient consultation","code_information":[{"code":"99254","type":"HCPCS"}],"standard_charges":[{"minimum":247.48,"maximum":1543.32,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1312.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":998.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":634.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":831.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":947.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Emergency dept visit","code_information":[{"code":"99281","type":"HCPCS"}],"standard_charges":[{"minimum":57.08,"maximum":57.08,"setting":"both","payers_information":[{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":31.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":41.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":140.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":214.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":24.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":222.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":38.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":26.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Emergency dept visit","code_information":[{"code":"99283","type":"HCPCS"}],"standard_charges":[{"minimum":29.52,"maximum":327.15,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":135.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":242.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":110.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":220.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":142.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":327.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":131.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":115.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":120.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":258.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":43.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":98.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":116.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":29.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":59.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":117.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":136.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Emergency dept visit","code_information":[{"code":"99284","type":"HCPCS"}],"standard_charges":[{"minimum":8.05,"maximum":2835.85,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":481.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":415.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":258.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":201.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":480.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":358.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":282.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":602.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":408.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":67.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":492.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":461.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":419.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":380.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":240.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":170.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":515.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1102.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":411.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":298.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":290.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":611.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":477.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":147.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":195.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2835.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":189.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":280.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":592.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":232.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":263.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":482.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":254.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":550.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Emergency dept visit","code_information":[{"code":"99285","type":"HCPCS"}],"standard_charges":[{"minimum":211.57,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1027.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":373.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1107.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":221.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":533.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":928.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":851.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1366.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1215.38,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":517.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1062.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1272.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":315.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":360.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":872.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":630.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1241.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":211.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":698.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":837.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":651.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":879.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":694.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1165.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1982.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Critical care first hour","code_information":[{"code":"99291","type":"HCPCS"}],"standard_charges":[{"minimum":219.10,"maximum":3085.44,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1012.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1018.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1372.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1046.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1133.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1599.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":951.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1025.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2434.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":855.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1493.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1617.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1316.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":328.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1115.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1465.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1143.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1102.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3085.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":830.64,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1490.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2866.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1286.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1420.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1690.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":219.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":735.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":827.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2183.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1504.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1703.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":786.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":965.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1551.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":554.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":480.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1092.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1451.44,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1291.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Critical care addl 30 min","code_information":[{"code":"99292","type":"HCPCS"}],"standard_charges":[{"minimum":12.24,"maximum":8008.42,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1012.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":897.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1348.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1541.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1680.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1993.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":12.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1150.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":8008.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":885.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1564.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1465.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1865.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":891.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1425.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1347.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1067.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":674.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":4072.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2691.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2489.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1169.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1892.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1008.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2524.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":892.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Init pm e/m new pat infant","code_information":[{"code":"99381","type":"HCPCS"}],"standard_charges":[{"minimum":45.32,"maximum":93.32,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Init pm e/m new pat 1-4 yrs","code_information":[{"code":"99382","type":"HCPCS"}],"standard_charges":[{"minimum":50.62,"maximum":112.67,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit new age 5-11","code_information":[{"code":"99383","type":"HCPCS"}],"standard_charges":[{"minimum":65.73,"maximum":100.45,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit new age 12-17","code_information":[{"code":"99384","type":"HCPCS"}],"standard_charges":[{"minimum":80.42,"maximum":118.24,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":118.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.61,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit new age 18-39","code_information":[{"code":"99385","type":"HCPCS"}],"standard_charges":[{"minimum":66.94,"maximum":158.25,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":69.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":94.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit new age 40-64","code_information":[{"code":"99386","type":"HCPCS"}],"standard_charges":[{"minimum":56.00,"maximum":124.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.86,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.63,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Init pm e/m new pat 65+ yrs","code_information":[{"code":"99387","type":"HCPCS"}],"standard_charges":[{"minimum":56.00,"maximum":119.66,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":114.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":113.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":111.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Per pm reeval est pat infant","code_information":[{"code":"99391","type":"HCPCS"}],"standard_charges":[{"minimum":47.74,"maximum":93.47,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":73.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":55.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":57.84,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit est age 1-4","code_information":[{"code":"99392","type":"HCPCS"}],"standard_charges":[{"minimum":52.17,"maximum":138.60,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":56.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.39,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit est age 5-11","code_information":[{"code":"99393","type":"HCPCS"}],"standard_charges":[{"minimum":25.68,"maximum":99.10,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.25,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":65.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":25.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.65,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit est age 12-17","code_information":[{"code":"99394","type":"HCPCS"}],"standard_charges":[{"minimum":68.26,"maximum":107.48,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":96.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.75,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":107.48,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit est age 18-39","code_information":[{"code":"99395","type":"HCPCS"}],"standard_charges":[{"minimum":53.26,"maximum":93.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":77.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":82.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":70.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":63.01,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":74.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prev visit est age 40-64","code_information":[{"code":"99396","type":"HCPCS"}],"standard_charges":[{"minimum":66.76,"maximum":101.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.07,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":79.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":97.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":86.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":68.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":92.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":85.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Per pm reeval est pat 65+ yr","code_information":[{"code":"99397","type":"HCPCS"}],"standard_charges":[{"minimum":83.55,"maximum":164.58,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":103.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":39.13,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.91,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":167.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Prolng ip/obs e/m ea 15 min","code_information":[{"code":"99418","type":"HCPCS"}],"standard_charges":[{"minimum":1308.57,"maximum":1308.57,"setting":"both","payers_information":[{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1308.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Phone e/m phys/qhp 5-10 min","code_information":[{"code":"99441","type":"HCPCS"}],"standard_charges":[{"minimum":11.80,"maximum":32.09,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":11.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":27.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":30.27,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":32.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":47.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":51.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":46.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":28.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":44.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.12,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":49.28,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.70,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Phone e/m phys/qhp 21-30 min","code_information":[{"code":"99443","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":185.00,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":40.36,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":91.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.16,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":185.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":87.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":21.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":104.29,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Init nb em per day hosp","code_information":[{"code":"99460","type":"HCPCS"}],"standard_charges":[{"minimum":99.43,"maximum":552.00,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":126.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":247.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.15,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":158.94,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":552.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":100.85,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":122.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":273.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":124.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.49,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":197.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":123.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":129.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":288.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":99.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":228.37,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Sbsq nb em per day hosp","code_information":[{"code":"99462","type":"HCPCS"}],"standard_charges":[{"minimum":10.00,"maximum":552.00,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":163.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":165.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":133.79,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":552.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":10.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":192.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":247.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":106.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":264.22,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":237.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":250.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":159.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":166.40,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Same day nb discharge","code_information":[{"code":"99463","type":"HCPCS"}],"standard_charges":[{"minimum":83.18,"maximum":83.18,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":83.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Attendance at delivery","code_information":[{"code":"99464","type":"HCPCS"}],"standard_charges":[{"minimum":597.05,"maximum":1028.99,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":770.77,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1028.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":597.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Nb resuscitation","code_information":[{"code":"99465","type":"HCPCS"}],"standard_charges":[{"minimum":66.45,"maximum":1893.73,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1052.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":66.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":893.46,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":833.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":756.51,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ped crit care transport","code_information":[{"code":"99466","type":"HCPCS"}],"standard_charges":[{"minimum":704.56,"maximum":3582.42,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":945.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ped crit care transport addl","code_information":[{"code":"99467","type":"HCPCS"}],"standard_charges":[{"minimum":704.56,"maximum":3582.42,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3582.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":704.56,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Neonate crit care initial","code_information":[{"code":"99468","type":"HCPCS"}],"standard_charges":[{"minimum":29.72,"maximum":2318.45,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":597.80,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":615.23,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":702.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Advncd care plan 30 min","code_information":[{"code":"99497","type":"HCPCS"}],"standard_charges":[{"minimum":2818.11,"maximum":2818.11,"setting":"both","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2818.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"CA screen;pelvic/breast exam","code_information":[{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"minimum":21.19,"maximum":41.61,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":36.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":425.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":265.09,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":281.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Colon ca scrn not hi rsk ind","code_information":[{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"minimum":241.48,"maximum":347.32,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":264.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":347.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Tomosynthesis, mammo","code_information":[{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"minimum":50.58,"maximum":226.45,"setting":"both","payers_information":[{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":95.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.14,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":226.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":128.11,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Initial preventive exam","code_information":[{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"minimum":72.35,"maximum":123.44,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":72.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"PPPS, initial visit","code_information":[{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"minimum":46.91,"maximum":153.30,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":134.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.31,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":153.30,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"PPPS, subseq visit","code_information":[{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"minimum":61.43,"maximum":139.59,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":130.53,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":101.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"CDSM NDSC","code_information":[{"code":"G1004","type":"HCPCS"}],"standard_charges":[{"minimum":0.98,"maximum":3848.74,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":199.95,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":581.67,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1193.87,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":202.66,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":342.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":137.10,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.55,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":329.04,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":185.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Blue Shield","plan_name":"Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":0.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":174.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":190.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":184.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":255.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":81.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":150.82,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":235.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":127.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":209.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":156.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":250.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1145.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":45.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":599.03,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":467.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medcost","plan_name":"Medcost","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":316.76,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1044.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Meritain Health","plan_name":"Meritain Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":139.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":138.68,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":363.19,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":236.02,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":160.52,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan","plan_name":"The Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.06,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":207.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":3848.74,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":162.69,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":245.97,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":375.93,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":188.21,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":207.05,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":249.96,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Administrator Claims","plan_name":"Us Administrator Claims","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":266.42,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":75.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":88.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":89.26,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":255.41,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":152.89,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":278.58,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":185.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Complex e/m visit add on","code_information":[{"code":"G2211","type":"HCPCS"}],"standard_charges":[{"minimum":48.17,"maximum":151.72,"setting":"both","payers_information":[{"payer_name":"Aetna","plan_name":"Aetna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":60.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicaid","plan_name":"Aetna Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":62.50,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":105.92,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":132.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":76.78,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":71.59,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":90.88,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":151.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":93.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Champva","plan_name":"Champva","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":141.35,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":48.17,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana","plan_name":"Humana","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicaid","plan_name":"Humana Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":54.24,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":119.81,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.33,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.62,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":109.57,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":108.08,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":61.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":58.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.34,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":112.73,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umr","plan_name":"Umr","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":64.71,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":102.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare","plan_name":"United Healthcare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":78.18,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":52.43,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":776.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2287.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":652.20,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2500.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ear mold/insert","code_information":[{"code":"V5264","type":"HCPCS"}],"standard_charges":[{"minimum":175.90,"maximum":2739.54,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":1488.83,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2739.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2522.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2665.45,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2420.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":776.98,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2287.99,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":249.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":175.90,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Battery for hearing device","code_information":[{"code":"V5266","type":"HCPCS"}],"standard_charges":[{"minimum":80.00,"maximum":80.00,"setting":"both","payers_information":[{"payer_name":"Cigna","plan_name":"Cigna","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":80.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hearing aid sup/access/dev","code_information":[{"code":"V5267","type":"HCPCS"}],"standard_charges":[{"minimum":22.00,"maximum":53.47,"setting":"both","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.72,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":53.47,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":22.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":35.32,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ald fm/dm transmitter ald","code_information":[{"code":"V5288","type":"HCPCS"}],"standard_charges":[{"minimum":2739.54,"maximum":5889.60,"setting":"both","payers_information":[{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":2739.54,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":5889.60,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Hearing service","code_information":[{"code":"V5299","type":"HCPCS"}],"standard_charges":[{"minimum":50.00,"maximum":50.00,"setting":"both","payers_information":[{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","estimated_amount":50.00,"standard_charge_algorithm":"Conditional payment logic at the claim level including adjustments as specified in the payer agreements.","methodology":"other"}],"billing_class":"professional"}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"minimum":115677.74,"maximum":472228.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":170289.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":472228.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185590.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":275700.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189210.27,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186482.15,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227134.74,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115677.74,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189210.27,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176384.77,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186482.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150181.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186695.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160251.18,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183644.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"minimum":47214.42,"maximum":154632.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86520.81,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129890.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99967.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127773.15,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119960.83,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127391.46,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":127658.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47214.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154632.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77324.75,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128576.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"minimum":50308.64,"maximum":50308.64,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50308.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"minimum":38047.2,"maximum":43634.01,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38047.2,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43634.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"minimum":26207.74,"maximum":26207.74,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26207.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"minimum":42780.79,"maximum":52096.55,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52096.55,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42780.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"minimum":18626.99,"maximum":18626.99,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18626.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"minimum":19122.29,"maximum":19122.29,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19122.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"minimum":29769.23,"maximum":29769.23,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29769.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"minimum":9639.69,"maximum":24961.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9639.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24961.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13996.03,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11620.03,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13540.95,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13675.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"minimum":9130.50,"maximum":17789.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9982.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17789.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9130.50,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9674.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10115.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9818.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"minimum":31209.55,"maximum":31209.55,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31209.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"minimum":17475.89,"maximum":19546.93,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19546.93,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17475.89,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18389.5,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18014.99,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19542.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"minimum":13771.05,"maximum":14930.31,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14350.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14930.31,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13998.91,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13771.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":7815.62,"maximum":11899.89,"setting":"inpatient","payers_information":[{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7815.62,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11899.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"minimum":8726.73,"maximum":38680.73,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38680.73,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8726.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":11623.94,"maximum":37351.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16291.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37351.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11623.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20682.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":8899.35,"maximum":37908.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8899.35,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17483.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21268.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23959.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22141.51,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17721.79,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":37908.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24815.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28827.26,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12963.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24196.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"minimum":10535.98,"maximum":10535.98,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10535.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10535.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":12234.87,"maximum":12234.87,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12234.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"minimum":25340.69,"maximum":25340.69,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25340.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"minimum":16402.39,"maximum":33750.0,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16402.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":33750.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":15998.34,"maximum":27344.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15998.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27344.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17233.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17775.93,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16556.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17030.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16176.1,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19412.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":6834.55,"maximum":31890.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9504.76,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7435.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14186.63,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7016.75,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8401.25,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":31890.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6834.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11181.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9071.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8208.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8929.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":5359.42,"maximum":9613.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5491.19,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6000.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9613.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5359.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5384.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":26495.2,"maximum":27261.0,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":27261.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":26495.2,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":9279.39,"maximum":42585.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13880.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42585.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15664.01,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14633.01,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":15652.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15981.16,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9279.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nonspecific Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":7699.1,"maximum":50104.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16066.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7699.1,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":50104.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":12218.9,"maximum":12218.9,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12218.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":8287.53,"maximum":9107.08,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9107.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8287.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":16984.31,"maximum":16984.31,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16984.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"minimum":7368.18,"maximum":7368.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7368.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"minimum":13219.34,"maximum":13219.34,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13219.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"minimum":8212.42,"maximum":8212.42,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8212.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":18197.21,"maximum":84282.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":84282.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18197.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20219.13,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19196.6,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59441.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":8477.0,"maximum":12037.58,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":8477.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12037.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"minimum":8162.02,"maximum":8754.0,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":8754.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8162.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":10809.08,"maximum":100043.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19566.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100043.19,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19105.28,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10809.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"minimum":7096.7,"maximum":24567.65,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24567.65,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7096.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":6832.7,"maximum":6832.7,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6832.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"minimum":31086.0,"maximum":31086.0,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":31086.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":8088.99,"maximum":14208.78,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14208.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8088.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":8229.67,"maximum":19013.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9004.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8229.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19013.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":36494.89,"maximum":36494.89,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36494.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"minimum":28543.32,"maximum":32150.2,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32150.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29256.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28543.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":19254.64,"maximum":19254.64,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19254.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"minimum":13973.53,"maximum":13973.53,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13973.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":7819.56,"maximum":18315.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15685.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18315.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7819.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16061.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15796.71,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7956.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12162.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16010.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17263.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":4795.22,"maximum":13941.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7265.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13941.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4795.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5200.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7857.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7937.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6393.63,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7700.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":6803.18,"maximum":6803.18,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6803.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"minimum":10449.38,"maximum":10449.38,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10449.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":6296.98,"maximum":6296.98,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6296.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":7119.01,"maximum":7119.01,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7119.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"minimum":30767.8,"maximum":30767.8,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30767.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"minimum":17738.33,"maximum":45652.61,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45652.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17738.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"minimum":80918.1,"maximum":80918.1,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":80918.1,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"minimum":8489.8,"maximum":8489.8,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8489.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"minimum":6224.13,"maximum":12024.46,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12024.46,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6224.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"minimum":9490.38,"maximum":9490.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9490.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":2443.41,"maximum":5934.19,"setting":"inpatient","payers_information":[{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2443.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5934.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":6834.13,"maximum":14768.85,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14768.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6834.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":13785.62,"maximum":13785.62,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13785.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":7579.26,"maximum":7579.26,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7579.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"minimum":30976.87,"maximum":43967.7,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41831.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43967.7,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40698.93,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30976.87,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38066.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42069.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"minimum":14382.16,"maximum":39791.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14382.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39791.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19076.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19032.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":14987.16,"maximum":16652.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14987.16,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16652.4,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15153.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":33924.34,"maximum":45740.02,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35494.35,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45740.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34865.53,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33924.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":8376.03,"maximum":8376.03,"setting":"inpatient","payers_information":[{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8376.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"minimum":25450.59,"maximum":65920.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25450.59,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":65920.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":4374.81,"maximum":12451.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11206.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12451.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11115.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10423.08,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4374.81,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6883.27,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6883.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12451.02,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8497.9,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11634.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":6586.73,"maximum":10555.0,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10555.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6941.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6586.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":8054.43,"maximum":24382.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14454.22,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14844.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24121.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15054.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13681.5,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22281.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9032.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13566.46,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":24382.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15054.95,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8054.43,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15054.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15054.95,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15755.29,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13700.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13073.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":5074.49,"maximum":12886.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5518.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9499.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8756.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12886.76,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8756.62,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6889.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12147.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8838.48,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8630.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7968.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5074.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":13684.96,"maximum":46747.73,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46747.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13804.38,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15722.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15425.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15212.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14306.56,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14037.59,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13684.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":8993.99,"maximum":9482.15,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9482.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8993.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":7454.28,"maximum":42032.05,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42032.05,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7454.28,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12677.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":6534.0,"maximum":9335.25,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9335.25,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9200.65,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":6534.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9335.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":6706.57,"maximum":6706.57,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6706.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":12534.66,"maximum":13853.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13579.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13774.35,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12852.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13853.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12534.66,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13606.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":8138.73,"maximum":49296.51,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49296.51,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8138.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":5424.36,"maximum":71708.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9840.22,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10775.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18871.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10787.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10933.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31260.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10197.73,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10933.57,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10161.77,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6065.31,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":71708.0,"methodology":"percent of total billed charges"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5424.36,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8497.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10744.75,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9949.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8864.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":7306.56,"maximum":17018.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8801.88,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7306.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17018.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9779.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9638.86,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9779.87,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8404.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9779.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9336.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8899.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9672.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":4990.02,"maximum":7534.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7486.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6992.3,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7534.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4990.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6800.27,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6752.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":4748.0,"maximum":4748.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4748.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":5394.17,"maximum":24942.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10595.8,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11127.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18489.10,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11986.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11773.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6447.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11026.72,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7296.74,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10446.97,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":24942.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11773.12,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5934.17,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5394.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11773.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10932.09,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10713.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10507.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":1101.81,"maximum":26768.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1101.81,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6636.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11293.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6324.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":45.27,"estimated_amount":14301.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6594.80,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7015.15,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":26768.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7015.15,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7296.74,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4701.57,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6640.03,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7135.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":5052.3,"maximum":9760.61,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9760.61,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5052.3,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5052.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":10059.87,"maximum":16578.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16401.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16578.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10059.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"minimum":60550.0,"maximum":60550.0,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":60550.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":3341.07,"maximum":29870.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15522.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29870.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15744.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15517.52,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3341.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15470.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":5255.64,"maximum":10678.0,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10678.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8346.04,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":7639.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5255.64,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8697.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8863.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"minimum":6060.85,"maximum":6177.89,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6177.89,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6060.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":6166.99,"maximum":25680.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7647.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14651.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8497.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7507.66,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6166.99,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6441.97,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":11694.6,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7178.90,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":25680.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8497.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7732.71,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7017.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":3051.88,"maximum":9365.36,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9365.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6166.99,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3051.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5418.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":14459.21,"maximum":15834.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14459.21,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15834.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":6456.4,"maximum":7377.37,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7377.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6456.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":33891.18,"maximum":67962.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44533.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67962.45,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61306.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58099.56,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61306.1,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33891.18,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67003.67,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60704.3,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55788.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58889.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":21595.76,"maximum":85485.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21595.76,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23638.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85485.61,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23995.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23763.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23995.29,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23652.86,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":43502.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23995.29,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23384.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21835.71,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23680.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"minimum":90651.96,"maximum":188082.28,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":188082.28,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90651.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90794.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"minimum":47525.97,"maximum":99491.04,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83125.31,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47525.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99491.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"minimum":51405.74,"maximum":51405.74,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51405.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"minimum":27773.89,"maximum":65603.72,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27773.89,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65603.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"minimum":42355.05,"maximum":48257.09,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48257.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46858.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43877.66,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46544.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45236.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42355.05,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45957.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"minimum":37541.79,"maximum":126305.6,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":126305.6,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37541.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"minimum":40692.22,"maximum":40692.22,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40692.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":25678.24,"maximum":49608.12,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49608.12,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27097.63,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28596.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25678.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26975.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"minimum":68923.18,"maximum":68923.18,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68923.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"minimum":51251.25,"maximum":51598.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51598.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51251.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"minimum":39807.79,"maximum":267067.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62296.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116962.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89882.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66620.48,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69218.74,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79690.79,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39807.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":267067.2,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68426.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62989.05,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66309.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"minimum":36588.40,"maximum":187009.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41516.6,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44735.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73851.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43454.37,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57674.15,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43541.06,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":162501.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36588.40,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":187009.6,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45824.28,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41977.9,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43800.40,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"minimum":26296.94,"maximum":58210.50,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54202.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52188.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49412.11,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58210.50,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52188.29,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52187.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26296.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49245.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"minimum":29599.54,"maximum":56981.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35039.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56981.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35864.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33901.63,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53124.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34378.09,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29599.54,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35864.25,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35962.80,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32636.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33975.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"minimum":34972.44,"maximum":42658.69,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39881.00,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42658.69,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41732.45,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36701.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34972.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"minimum":22686.92,"maximum":23932.87,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23802.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23932.87,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22686.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":16011.34,"maximum":64275.83,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64275.83,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29841.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30859.82,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16011.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29183.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":14322.78,"maximum":49864.10,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18505.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49864.10,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14322.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19357.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18615.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18393.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":14732.86,"maximum":54249.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54249.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15279.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15897.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16331.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14732.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":19028.03,"maximum":32732.51,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32732.51,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28948.25,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19028.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":13708.39,"maximum":13914.56,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13914.56,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13708.39,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13893.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"minimum":27085.06,"maximum":36941.91,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29363.89,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36941.91,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27085.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"minimum":13298.08,"maximum":103420.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":103420.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20376.11,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22432.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21746.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20970.42,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13298.08,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20714.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20602.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"minimum":13858.57,"maximum":15209.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13858.57,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15209.7,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14828.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"minimum":21517.84,"maximum":41914.3,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41914.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24070.5,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21517.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"minimum":13474.65,"maximum":14346.57,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13474.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14346.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"minimum":14444.97,"maximum":14444.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14444.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"minimum":29421.24,"maximum":39257.13,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39257.13,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29421.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"minimum":14960.83,"maximum":14960.83,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14960.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":22266.02,"maximum":28984.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26086.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22266.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26886.04,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28984.62,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26376.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"minimum":50443.09,"maximum":98074.65,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98074.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53906.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56936.60,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50443.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"minimum":39412.17,"maximum":43539.35,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42551.38,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42442.37,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43539.35,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39412.17,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42666.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"minimum":33584.58,"maximum":37105.49,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36906.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35215.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37105.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33584.58,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36786.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":25808.84,"maximum":71985.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40390.41,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43310.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46039.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71985.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42364.39,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44275.22,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44878.24,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25808.84,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44878.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32037.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40839.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42201.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"minimum":22776.65,"maximum":46669.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22776.65,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28125.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46669.43,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30271.93,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30672.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38016.01,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27912.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29978.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"minimum":19402.03,"maximum":19402.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19402.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"minimum":28350.9,"maximum":47549.07,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47549.07,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28350.9,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34781.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"minimum":26172.48,"maximum":97026.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28236.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46878.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28070.74,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28294.78,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":97026.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28721.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26172.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28052.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"minimum":56820.65,"maximum":177180.60,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177180.60,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61574.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56820.65,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64182.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"minimum":49602.03,"maximum":52616.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49602.03,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52616.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"minimum":19214.7,"maximum":244929.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":244929.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19214.7,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42442.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"minimum":36021.9,"maximum":36021.9,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36021.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":7999.08,"maximum":72222.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12671.67,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13876.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24402.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8678.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12363.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11773.12,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12031.80,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":72222.3,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14079.64,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10572.41,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7999.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":40581.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12885.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12812.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12903.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":6405.94,"maximum":74456.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":74456.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7000.39,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7048.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12044.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8102.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8117.52,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11817.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8102.55,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7148.83,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":37170.9,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":34382.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7009.10,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6405.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7373.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7348.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":4979.69,"maximum":6305.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4979.69,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6305.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5436.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5799.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"minimum":8982.66,"maximum":21701.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8982.66,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16957.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21701.05,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16900.24,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17495.49,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14807.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17883.86,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15038.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":16624.89,"maximum":32581.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20619.22,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18853.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32581.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19130.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16985.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19130.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18863.78,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19130.2,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19130.2,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18071.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17408.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16624.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":8190.95,"maximum":14218.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8638.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9598.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9024.04,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14218.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8190.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8302.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"minimum":11954.28,"maximum":22680.18,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22680.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11954.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":5773.53,"maximum":96220.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5773.53,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10333.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19051.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15168.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11394.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10015.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10073.47,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17416.21,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11003.49,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11394.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":96220.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11394.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11454.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10368.69,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10757.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":2096.02,"maximum":29344.76,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13363.11,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7601.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29344.76,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2096.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"minimum":4534.64,"maximum":4534.64,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4534.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"minimum":25094.95,"maximum":25094.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":25094.95,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":8144.55,"maximum":18289.0,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13786.54,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8144.55,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":18289.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13175.85,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12729.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":6654.99,"maximum":15237.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9312.34,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15237.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13748.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9469.25,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8171.43,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6654.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7951.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8617.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":5061.81,"maximum":15279.96,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15279.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5342.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5061.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"minimum":17491.4,"maximum":17491.4,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17491.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"minimum":3706.83,"maximum":3706.83,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3706.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":7907.47,"maximum":10196.88,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9341.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7907.47,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10196.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":5169.65,"maximum":6632.23,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6632.23,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5169.65,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6085.22,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6212.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"minimum":12577.57,"maximum":12577.57,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12577.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":13993.15,"maximum":13993.15,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13993.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":9042.82,"maximum":45214.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9559.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9972.19,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9042.82,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":45214.2,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10669.11,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10727.25,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9527.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":4035.0,"maximum":15629.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5948.06,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15629.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9149.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4702.13,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4965.26,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10268.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5869.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6014.14,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6544.86,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4035.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":3722.9,"maximum":26840.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8379.82,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4465.99,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":26840.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":15044.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4739.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4465.99,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3722.9,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5030.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":6973.57,"maximum":59933.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7555.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13472.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.75,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":59933.7,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7663.26,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6973.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":4164.0,"maximum":38130.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6329.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38130.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6421.7,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5033.18,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4164.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6323.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":5688.21,"maximum":53605.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6019.69,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18382.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25474.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18329.45,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17534.93,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5688.21,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53605.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18579.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18012.43,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16906.97,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16597.64,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26311.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":7726.01,"maximum":8057.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7726.01,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7943.7,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8057.21,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7811.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"minimum":35922.7,"maximum":36094.2,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36094.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35922.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":17762.22,"maximum":164596.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22960.77,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24871.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26873.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17762.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25511.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25148.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24051.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":164596.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25511.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25579.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23215.89,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24669.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":14563.84,"maximum":97696.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14563.84,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15463.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40985.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15922.57,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16182.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15189.1,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14638.05,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":97696.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16182.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16005.66,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14725.66,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15638.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"minimum":34569.81,"maximum":35633.1,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35633.1,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34569.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"minimum":23974.22,"maximum":25977.49,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24809.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25977.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23974.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":13550.0,"maximum":73510.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47890.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73510.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45142.21,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42386.07,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":13550.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45074.37,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43940.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56316.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":5125.51,"maximum":36594.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5125.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36594.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11974.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12228.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20244.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13613.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21815.08,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13079.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19559.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"minimum":12441.58,"maximum":24921.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12757.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24921.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14175.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12739.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12899.69,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12441.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":3460.49,"maximum":124494.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22061.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36009.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40085.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37648.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38847.13,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124494.94,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":41978.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3460.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39847.36,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35889.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75316.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":18946.41,"maximum":123755.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18946.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38104.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18999.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21051.56,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18984.04,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":123755.4,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21051.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20426.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19156.92,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29763.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":13354.58,"maximum":73136.10,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13354.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73136.10,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13757.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14838.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14628.86,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13502.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"minimum":60428.51,"maximum":60428.51,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60428.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":10468.56,"maximum":64456.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17002.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64456.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18683.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18814.44,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17662.61,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10468.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17873.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":11952.03,"maximum":12362.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11952.03,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12362.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"minimum":21764.43,"maximum":21764.43,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21764.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"minimum":10086.15,"maximum":10086.15,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10086.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"minimum":12762.99,"maximum":20998.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20998.36,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12762.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":10507.05,"maximum":34688.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":34688.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13309.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15355.37,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10507.05,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15297.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":18926.48,"maximum":18926.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18926.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"minimum":37471.87,"maximum":48417.42,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48417.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37471.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"minimum":17590.32,"maximum":19495.83,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19495.83,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17590.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19495.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":6637.68,"maximum":53763.38,"setting":"inpatient","payers_information":[{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53763.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6637.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":6504.92,"maximum":6504.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6504.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"minimum":7033.62,"maximum":7033.62,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7033.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":14114.31,"maximum":25948.08,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25948.08,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15510.23,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15769.53,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14114.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":7217.37,"maximum":32159.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8325.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9250.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7217.37,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":32159.7,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9305.79,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8417.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":5786.41,"maximum":6291.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6291.46,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5786.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":16951.39,"maximum":25879.50,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25879.50,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17492.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16951.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":10484.3,"maximum":72227.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10484.3,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16862.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18695.88,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10484.3,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":72227.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10705.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":6691.58,"maximum":15888.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15669.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15707.08,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14027.57,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15888.29,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7454.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15183.6,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14458.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6691.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":5408.35,"maximum":9535.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9535.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5504.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8559.8,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8730.88,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5408.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5820.59,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8781.1,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7945.1,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7649.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":5619.43,"maximum":5619.43,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5619.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":4205.87,"maximum":8748.95,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6004.71,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4205.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8748.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"minimum":5895.47,"maximum":5895.47,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5895.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"minimum":13707.34,"maximum":13707.34,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13707.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":8500.83,"maximum":8500.83,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8500.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":10519.84,"maximum":10519.84,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10519.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":9920.7,"maximum":12899.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9920.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11514.61,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12899.31,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11738.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":4626.82,"maximum":17402.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6361.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4931.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12425.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5366.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4626.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":17402.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7140.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6431.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6646.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":4464.84,"maximum":9436.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4464.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4922.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4960.93,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9436.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4991.19,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4894.27,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6984.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":6274.73,"maximum":11507.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6274.73,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11158.15,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9614.66,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11321.4,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11507.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11334.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":2234.98,"maximum":51448.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6274.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12112.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6971.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2234.98,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":45.27,"estimated_amount":10554.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5069.24,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":51448.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6971.93,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6971.93,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6944.61,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6344.46,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6395.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":12201.0,"maximum":36298.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15514.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36298.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14101.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12201.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14373.25,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14197.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":5609.21,"maximum":22801.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":22801.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7566.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9864.18,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5609.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":14032.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8988.33,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7566.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6731.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":4928.49,"maximum":5746.34,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5746.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4928.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5229.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":10232.63,"maximum":19893.0,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19893.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10232.63,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12221.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":5755.1,"maximum":5755.1,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5755.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"minimum":45829.71,"maximum":71245.76,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71245.76,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45829.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"minimum":1988.36,"maximum":1988.36,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1988.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"minimum":31830.84,"maximum":31830.84,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31830.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"minimum":10883.46,"maximum":10883.46,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10883.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"minimum":29237.6,"maximum":44464.73,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44464.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29237.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"minimum":15956.43,"maximum":17314.35,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17314.35,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15956.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"minimum":9726.06,"maximum":10475.08,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10475.08,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9726.06,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10439.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":8422.94,"maximum":79504.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18391.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58790.67,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18612.09,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":79504.2,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8422.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18718.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19534.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":13201.72,"maximum":38361.45,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38361.45,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13273.5,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14507.39,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13201.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":9281.15,"maximum":11654.2,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11654.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10605.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9281.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"minimum":8201.14,"maximum":8201.14,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8201.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"minimum":19593.88,"maximum":19593.88,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19593.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":8819.33,"maximum":25409.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13547.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25409.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17003.83,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16532.28,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17003.83,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8819.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15381.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15473.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15646.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":5003.95,"maximum":9198.21,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8326.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9149.76,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7092.14,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5003.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9149.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9198.21,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8326.28,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8626.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":10067.43,"maximum":15425.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15425.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11558.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14801.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10067.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":8791.5,"maximum":9768.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8791.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9768.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9669.09,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8889.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":12782.94,"maximum":25536.62,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25536.62,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12782.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13785.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":4471.88,"maximum":10412.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7492.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10412.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8356.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6901.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7589.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6554.07,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9486.76,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4471.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6906.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6926.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":1459.55,"maximum":8985.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1459.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8985.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5463.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6123.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5398.47,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5463.24,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4018.45,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4971.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":5277.65,"maximum":54427.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7974.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28523.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5277.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11384.70,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":54427.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16224.64,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8298.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16310.53,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14764.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16224.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":7684.26,"maximum":72945.0,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":72945.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8491.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7684.26,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8387.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"minimum":9618.87,"maximum":13896.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13896.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9618.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12261.4,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13853.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13717.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":6623.01,"maximum":8776.92,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8638.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8006.51,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6623.01,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8776.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8337.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"minimum":7012.58,"maximum":21470.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7012.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12505.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":21470.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7113.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"minimum":32045.11,"maximum":32045.11,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32045.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"minimum":17295.56,"maximum":61482.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61482.79,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17295.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50263.37,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50564.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"minimum":24239.11,"maximum":69494.0,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26154.83,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33994.61,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":69494.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26636.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25279.17,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24239.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"minimum":45396.09,"maximum":47217.25,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46029.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45396.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47217.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":20349.25,"maximum":44429.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29187.65,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44429.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30939.7,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25629.54,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23976.94,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20349.25,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28155.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":21322.6,"maximum":59123.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21322.6,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23357.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41640.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22165.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23364.16,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":59123.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23327.18,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22713.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":30383.35,"maximum":30383.35,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30383.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":15196.48,"maximum":16489.61,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15373.9,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16455.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16489.61,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15196.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15693.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"minimum":24821.54,"maximum":43703.29,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43654.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24821.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43703.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"minimum":24797.18,"maximum":24797.18,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24797.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"minimum":79819.2,"maximum":79819.2,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":79819.2,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"minimum":34749.13,"maximum":37635.28,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37635.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37635.28,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34749.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"minimum":11417.83,"maximum":18723.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18723.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16772.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18503.58,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11417.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17320.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"minimum":10444.58,"maximum":10444.58,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10444.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"minimum":27951.56,"maximum":29898.71,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29898.71,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27951.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"minimum":19250.6,"maximum":21154.51,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21154.51,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19250.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":10148.11,"maximum":173537.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":108916.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26725.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173537.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23795.12,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25154.16,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17152.5,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25260.56,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10148.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":11354.24,"maximum":73977.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16572.62,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17151.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29134.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16937.56,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14096.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16704.08,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":73977.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11354.24,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11354.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":56708.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18315.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16756.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18151.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":9897.3,"maximum":24782.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13897.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24782.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13226.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13540.47,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9897.3,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12573.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12827.82,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12913.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"minimum":31333.5,"maximum":31333.5,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31333.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"minimum":29340.0,"maximum":29340.0,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":29340.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":9995.59,"maximum":9995.59,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9995.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"minimum":13337.02,"maximum":113823.0,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13337.02,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":113823.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28787.22,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23634.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27959.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":19182.83,"maximum":111424.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19182.83,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20167.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20213.8,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19279.18,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":111424.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21314.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20587.07,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19479.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":8553.98,"maximum":16588.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8794.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16588.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16588.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14903.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13556.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8553.98,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15095.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15970.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"minimum":16127.37,"maximum":16127.37,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16127.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":12859.04,"maximum":27080.39,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27080.39,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12859.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15403.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"minimum":6222.41,"maximum":10765.19,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6222.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10765.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":13158.22,"maximum":13876.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13158.22,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13876.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"minimum":15137.49,"maximum":15137.49,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15137.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"minimum":21971.38,"maximum":194575.5,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":194575.5,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21971.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"minimum":15503.66,"maximum":15503.66,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15503.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":14084.59,"maximum":14084.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14084.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"minimum":27828.28,"maximum":27828.28,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27828.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":24165.64,"maximum":75269.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75269.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24165.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26141.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26284.39,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24180.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":10892.34,"maximum":18745.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16664.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18042.56,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17923.24,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10892.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18745.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17110.41,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16973.29,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18399.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":9865.01,"maximum":9865.01,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9865.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"minimum":13109.69,"maximum":17610.86,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13109.69,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17610.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"minimum":10484.18,"maximum":61410.08,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61410.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10484.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"minimum":15955.97,"maximum":15955.97,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15955.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":5164.69,"maximum":6959.3,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5164.69,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6959.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"minimum":10531.76,"maximum":10531.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10531.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":15202.85,"maximum":15202.85,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15202.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":2381.0,"maximum":26255.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7387.26,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2381.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":26255.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8575.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7824.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7663.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6222.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":11606.72,"maximum":11606.72,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11606.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":7093.91,"maximum":7093.91,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7093.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":11744.59,"maximum":39616.86,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16422.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22760.66,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39616.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11744.59,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14727.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":13691.28,"maximum":28073.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17663.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26287.25,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28073.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13691.28,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19488.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.81,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21905.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":11979.87,"maximum":19428.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11979.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15112.72,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18824.69,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":19428.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12099.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"minimum":11071.6,"maximum":13301.1,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13301.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12828.89,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11071.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":12505.05,"maximum":13861.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13772.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12505.05,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13861.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"minimum":8878.81,"maximum":54309.0,"setting":"inpatient","payers_information":[{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8878.81,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":54309.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22886.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"minimum":13513.52,"maximum":26397.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13513.52,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14803.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26397.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14848.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13663.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14843.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"minimum":5441.29,"maximum":5441.29,"setting":"inpatient","payers_information":[{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5441.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":13047.47,"maximum":15500.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15500.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13677.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14942.9,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15500.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13047.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"minimum":10875.86,"maximum":20409.26,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20409.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11782.7,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10875.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"minimum":10548.05,"maximum":10737.44,"setting":"inpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10737.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10548.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"minimum":9681.44,"maximum":9681.44,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9681.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":12012.96,"maximum":12694.51,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12694.51,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12012.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":5338.20,"maximum":13690.44,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13690.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7160.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6520.55,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5338.20,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6455.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7144.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7799.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"minimum":49471.0,"maximum":49471.0,"setting":"inpatient","payers_information":[{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":49471.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"minimum":24342.82,"maximum":32479.92,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32479.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32362.56,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24342.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":9585.16,"maximum":30216.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15850.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30216.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15368.41,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17611.75,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15861.11,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":28000.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9585.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17611.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16026.69,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17517.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"minimum":9380.2,"maximum":9380.2,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9380.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"minimum":12705.19,"maximum":25309.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12956.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25309.56,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14031.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12705.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"minimum":6973.17,"maximum":37169.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6973.17,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12956.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23672.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13465.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13465.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13035.77,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25893.5,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":37169.6,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12253.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"minimum":8627.31,"maximum":31501.36,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31501.36,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8627.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":14578.62,"maximum":37469.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":37469.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29041.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16461.93,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16519.27,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14736.09,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16519.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15216.81,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14578.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"minimum":10621.47,"maximum":10621.47,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10621.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"minimum":11826.37,"maximum":11826.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11826.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"minimum":35160.67,"maximum":35160.67,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35160.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"minimum":9417.93,"maximum":80173.16,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80173.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20081.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19206.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19783.76,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9417.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18274.23,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18862.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":7462.66,"maximum":47010.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7462.66,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20414.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36024.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12862.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12085.67,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":45.27,"estimated_amount":47010.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11985.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":26039.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10421.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11674.58,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11704.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":4047.45,"maximum":14568.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4047.45,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8060.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12157.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7981.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6335.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7896.28,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7981.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8007.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7263.49,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7866.78,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14568.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":5027.27,"maximum":5524.47,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5524.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5027.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":6836.72,"maximum":23196.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10504.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6836.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23196.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10347.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9527.71,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10835.07,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10621.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10405.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":4058.32,"maximum":19498.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6241.19,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6819.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11261.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6934.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6149.88,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4817.87,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4058.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":19498.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6286.45,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6310.53,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6869.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"minimum":10525.37,"maximum":10525.37,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10525.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":12453.68,"maximum":53593.82,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53593.82,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12453.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16555.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13285.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13274.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"minimum":5318.61,"maximum":225338.4,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5318.61,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":225338.4,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8513.14,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8574.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":6678.95,"maximum":6678.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6678.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"minimum":28018.7,"maximum":28018.7,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28018.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"minimum":14349.82,"maximum":42265.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28593.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15518.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":42265.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16555.14,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14349.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"minimum":12485.6,"maximum":55855.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12485.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23097.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12948.6,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":52389.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":55855.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"minimum":20892.18,"maximum":40392.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20892.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40392.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21754.43,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22644.31,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":32559.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20907.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":9567.17,"maximum":24345.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11011.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20998.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10615.77,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11509.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":24345.0,"methodology":"percent of total billed charges"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10389.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10869.4,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9567.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":6084.96,"maximum":15109.08,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15109.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13085.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8395.84,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6084.96,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9393.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8466.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"minimum":26485.0,"maximum":26485.0,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26485.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"minimum":15026.2,"maximum":15026.2,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15026.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"minimum":11378.05,"maximum":11378.05,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11378.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"minimum":11976.13,"maximum":12753.26,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12753.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12475.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11976.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":14489.82,"maximum":50644.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14489.82,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32345.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50644.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30321.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30022.69,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31179.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"minimum":19027.08,"maximum":122585.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":83157.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19027.08,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34553.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21141.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20869.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19687.64,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21141.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":122585.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19238.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":11626.83,"maximum":17471.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11987.17,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16891.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17471.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11626.83,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11917.78,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13319.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13318.95,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12120.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12041.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":4820.49,"maximum":13578.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7194.86,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7879.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13578.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7012.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6897.84,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4820.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9514.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7026.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7274.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6152.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":3731.22,"maximum":11269.17,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11269.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5033.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4282.51,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3731.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4654.61,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5400.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"minimum":9835.27,"maximum":9835.27,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9835.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":8523.07,"maximum":16142.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10307.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16142.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10291.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8598.77,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10422.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9352.58,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9484.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8523.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":6444.86,"maximum":15411.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":13563.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6444.86,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7100.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11196.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6769.7,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7160.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6972.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":15411.2,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7200.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6516.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7109.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":11819.7,"maximum":11819.7,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11819.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":6093.09,"maximum":6093.09,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6093.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":8352.13,"maximum":105458.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10034.46,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8909.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24811.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14487.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12290.02,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8352.13,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":105458.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10209.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13360.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13030.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":5727.71,"maximum":14617.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5727.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14617.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6998.37,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8770.26,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8243.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"minimum":5906.19,"maximum":13113.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5906.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":13113.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"minimum":12471.78,"maximum":12471.78,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12471.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"minimum":7823.18,"maximum":18840.0,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18840.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7823.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"minimum":16291.05,"maximum":16291.05,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16291.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"minimum":11003.36,"maximum":11003.36,"setting":"inpatient","payers_information":[{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11003.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":3257.48,"maximum":13118.56,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3257.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13118.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":9384.24,"maximum":33945.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17077.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9874.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":33945.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10123.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9384.24,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13483.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"minimum":12296.52,"maximum":12296.52,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12296.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"minimum":16205.77,"maximum":16205.77,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16205.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"minimum":11601.07,"maximum":11601.07,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11601.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"minimum":8016.17,"maximum":8924.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8924.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8016.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"minimum":8833.83,"maximum":8833.83,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8833.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":5257.6,"maximum":20848.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9729.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16577.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16154.44,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5257.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":20848.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9837.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":13701.57,"maximum":13701.57,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13701.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":2518.89,"maximum":9199.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5724.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9199.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6360.47,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6360.47,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6360.47,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2518.9,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2518.89,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":5821.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5788.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":4788.0,"maximum":14308.94,"setting":"inpatient","payers_information":[{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4788.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14308.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":4515.34,"maximum":15871.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8179.68,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11148.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15871.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9088.53,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7688.11,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5727.51,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9088.53,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.35,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8270.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":7688.11,"maximum":59007.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13426.90,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7688.11,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":59007.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":6903.86,"maximum":27295.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13973.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27295.7,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8409.82,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6903.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8688.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14128.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":3672.34,"maximum":25947.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8395.33,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11239.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16399.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3672.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9328.15,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13817.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":25947.45,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5618.81,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9328.15,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3929.77,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":24035.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9328.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8488.62,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8334.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":3333.21,"maximum":26051.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6829.05,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9157.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11973.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7587.83,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5618.81,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":26051.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7587.83,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3333.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":22893.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6904.93,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10683.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":2272.66,"maximum":108271.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20275.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16146.54,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2272.66,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13123.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":108271.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16146.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14693.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":6418.01,"maximum":53248.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33367.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51723.53,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38174.09,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6418.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53248.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48456.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":2209.20,"maximum":36365.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32729.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20623.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13724.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33747.89,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36012.91,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2209.20,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15789.50,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36365.67,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4027.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":36360.8,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26853.46,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33092.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":1762.98,"maximum":19967.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19748.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2587.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7314.25,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10216.25,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1762.98,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2307.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4820.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1928.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19967.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":3415.0,"maximum":54474.80,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":3415.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33620.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8259.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37356.08,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54474.80,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23443.46,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13724.28,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37356.08,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":75.0,"estimated_amount":13057.5,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33994.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":3146.92,"maximum":13222.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":6560.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11900.11,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3146.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4920.00,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6436.05,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4877.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6120.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4017.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13222.35,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12032.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1566.08,"maximum":7124.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":2826.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1611.02,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2244.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2850.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1566.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1790.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1790.02,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":3722.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1566.08,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3142.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1566.08,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1790.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7124.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1790.02,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1628.92,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2076.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"minimum":42272.0,"maximum":45105.22,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":42272.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45105.22,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44019.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":4283.86,"maximum":14308.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8052.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14308.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8947.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8947.42,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5801.09,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8947.42,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4283.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5801.09,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8142.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":2437.92,"maximum":26544.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":18381.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5964.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10636.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4581.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6626.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6626.71,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":13028.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":26544.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4581.17,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6626.71,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2437.92,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2437.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":6627.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6626.71,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6030.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":2154.28,"maximum":19752.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":19752.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5226.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9899.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4122.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5806.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19682.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10208.39,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5806.69,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4122.97,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2931.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4581.17,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5806.69,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2154.28,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2154.28,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":18690.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5806.69,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5284.09,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8176.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"minimum":9260.52,"maximum":19539.26,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19156.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19539.26,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17687.11,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9260.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":9726.65,"maximum":34807.86,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34807.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9956.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10749.51,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10688.63,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10745.21,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9726.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":11090.26,"maximum":12524.26,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11409.55,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11090.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12524.26,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11639.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":6733.9,"maximum":13141.20,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13141.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7884.05,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6733.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8043.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7273.99,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6922.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":11488.04,"maximum":13844.46,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13844.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12110.09,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11488.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12694.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12598.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":17644.6,"maximum":17644.6,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17644.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":7054.47,"maximum":8029.09,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7054.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8029.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"minimum":24998.13,"maximum":24998.13,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24998.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"minimum":7326.49,"maximum":7326.49,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7326.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"minimum":51114.95,"maximum":51114.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51114.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"minimum":55994.78,"maximum":55994.78,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55994.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":6057.68,"maximum":14795.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6057.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14795.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9542.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8552.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":5450.75,"maximum":9849.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5892.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9849.6,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5450.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":4133.27,"maximum":7240.69,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7240.69,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4542.05,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4133.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"minimum":18053.75,"maximum":18053.75,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18053.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"minimum":25246.2,"maximum":25291.39,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25291.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25246.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"minimum":7779.48,"maximum":13964.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7779.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11739.22,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13964.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"minimum":74295.9,"maximum":74295.9,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":74295.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"minimum":18918.99,"maximum":18918.99,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18918.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":21746.86,"maximum":77286.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25024.26,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56008.61,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64620.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44367.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44084.78,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77286.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22975.59,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43345.49,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23430.3,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26665.04,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21746.86,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25024.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":44654.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30980.96,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43376.91,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40374.02,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42614.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":6099.59,"maximum":37937.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16279.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37937.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18088.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16838.98,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15891.65,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13003.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":29739.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6099.59,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11006.1,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18088.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17190.65,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16460.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10243.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"minimum":20567.73,"maximum":20567.73,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20567.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"minimum":28601.32,"maximum":37183.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35370.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33447.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37183.07,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28601.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35763.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"minimum":10179.0,"maximum":19059.63,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18953.6,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18683.11,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":10179.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19059.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":6024.81,"maximum":69469.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27554.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16347.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14129.5,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17823.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6024.81,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16347.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":69469.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16616.18,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14875.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14131.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":4930.16,"maximum":12564.01,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7927.5,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4930.16,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12564.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":7129.44,"maximum":21362.0,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":21362.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7129.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":7411.29,"maximum":14017.96,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14017.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7411.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":24733.12,"maximum":313927.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42741.7,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60960.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313927.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61811.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59917.12,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203695.77,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60273.09,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101680.73,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61811.07,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54755.38,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29853.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24733.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60781.75,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56248.07,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60751.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":9835.86,"maximum":58758.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":30669.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15835.4,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17345.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30350.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19578.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17594.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17016.66,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25658.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17594.88,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15302.8,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":58758.3,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9894.79,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17594.88,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9835.86,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31299.45,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9835.86,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":27129.06,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17594.88,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17594.72,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21305.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16011.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15971.11,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24773.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":4105.36,"maximum":60143.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8226.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4105.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16068.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9140.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8574.57,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7570.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7108.59,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6998.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9140.01,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5040.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":60143.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9140.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8317.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8317.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8052.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":2337.85,"maximum":15053.82,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15053.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2337.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"minimum":2337.85,"maximum":28054.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2337.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28054.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13773.98,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26885.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15562.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15196.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14412.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":6229.64,"maximum":31272.25,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31272.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7516.3,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7013.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7637.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7013.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6229.64,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10691.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":23925.23,"maximum":37713.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28054.2,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37713.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23925.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32039.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":15505.54,"maximum":16702.03,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15505.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16504.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16702.03,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16184.98,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16329.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"minimum":10953.39,"maximum":37241.06,"setting":"inpatient","payers_information":[{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16916.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37241.06,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10953.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":5682.36,"maximum":39954.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12746.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8277.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39954.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11814.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14163.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13958.86,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14163.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13609.96,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5682.36,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14163.06,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6941.83,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14163.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14093.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12888.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12061.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":3641.74,"maximum":35697.0,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35697.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7204.08,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7640.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3641.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6123.86,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6952.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":7591.92,"maximum":51840.63,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14234.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7591.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25689.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51840.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":8024.52,"maximum":9074.96,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9074.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8024.52,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8973.57,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8348.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":3960.97,"maximum":3960.97,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3960.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"minimum":11814.55,"maximum":13328.99,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11814.55,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13328.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"minimum":16302.65,"maximum":17852.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16302.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17852.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"minimum":10339.88,"maximum":10339.88,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10339.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"minimum":15060.39,"maximum":15060.39,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15060.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"minimum":28957.31,"maximum":28957.31,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28957.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":3895.97,"maximum":62978.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":62978.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11193.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3895.97,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16197.63,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6190.18,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15222.39,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14692.46,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11119.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":10376.04,"maximum":19288.12,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13198.69,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10376.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19288.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12963.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18998.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"minimum":9412.76,"maximum":24693.84,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9412.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9574.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11979.87,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22744.15,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":11272.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23293.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12099.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24693.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"minimum":5134.23,"maximum":11486.16,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8967.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5134.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10944.04,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11486.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7971.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"minimum":65319.0,"maximum":65319.0,"setting":"inpatient","payers_information":[{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":65319.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"minimum":31320.09,"maximum":270193.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34046.24,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":270193.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33848.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31320.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"minimum":56645.46,"maximum":110531.47,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110531.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62986.11,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":63357.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64185.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56645.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"minimum":32306.58,"maximum":32306.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32306.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"minimum":20451.5,"maximum":20451.5,"setting":"inpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20451.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":23744.59,"maximum":51235.96,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51235.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23744.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"minimum":11561.0,"maximum":69022.2,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69022.2,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":11561.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12121.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"minimum":28950.25,"maximum":28950.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28950.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"minimum":12098.82,"maximum":12098.82,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12098.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":23177.86,"maximum":224863.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207947.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68825.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40785.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40836.23,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":224863.2,"methodology":"percent of total billed charges"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23177.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69743.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38283.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40507.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":3382.06,"maximum":89162.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19856.15,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21425.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3382.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13422.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":89162.4,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20655.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21425.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":14079.64,"maximum":239268.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61373.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29567.6,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14079.64,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":239268.6,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30125.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":13542.19,"maximum":38785.36,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38785.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13542.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13547.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate","code_information":[{"code":"0800","type":"APC"}],"standard_charges":[{"minimum":1155.61,"maximum":1155.61,"setting":"outpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1155.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Goserelin acetate implant","code_information":[{"code":"0810","type":"APC"}],"standard_charges":[{"minimum":1654.08,"maximum":2655.2,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2655.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1654.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Euflexxa inj per dose","code_information":[{"code":"0875","type":"APC"}],"standard_charges":[{"minimum":46.54,"maximum":229.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.54,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":229.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Orthovisc inj per dose","code_information":[{"code":"0877","type":"APC"}],"standard_charges":[{"minimum":376.22,"maximum":376.22,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":376.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection,onabotulinumtoxinA","code_information":[{"code":"0902","type":"APC"}],"standard_charges":[{"minimum":316.36,"maximum":2322.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1374.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":316.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":983.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1223.5,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2322.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1983.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":449.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Octreotide injection, depot","code_information":[{"code":"1207","type":"APC"}],"standard_charges":[{"minimum":2487.16,"maximum":13471.84,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13471.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2487.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4289.4,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6257.50,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4963.97,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3638.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"AbobotulinumtoxinA","code_information":[{"code":"1289","type":"APC"}],"standard_charges":[{"minimum":2184.37,"maximum":2184.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2184.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gel-one","code_information":[{"code":"1417","type":"APC"}],"standard_charges":[{"minimum":372.64,"maximum":11226.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1169.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1714.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1269.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":11226.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":372.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Calcitonin salmon injection","code_information":[{"code":"1433","type":"APC"}],"standard_charges":[{"minimum":2581.45,"maximum":6358.29,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6358.29,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2581.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Monovisc inj per dose","code_information":[{"code":"1747","type":"APC"}],"standard_charges":[{"minimum":100.0,"maximum":1339.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":100.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1089.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1339.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":553.28,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1094.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":505.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Penicillin g benzathine inj","code_information":[{"code":"1829","type":"APC"}],"standard_charges":[{"minimum":853.97,"maximum":853.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":853.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"minimum":20.2,"maximum":287.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":273.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.54,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.57,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":124.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.82,"estimated_amount":243.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.60,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.57,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":170.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":176.91,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":120.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.57,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":144.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.76,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":253.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.53,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.54,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":71.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22.23,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.22,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.2,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":121.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":230.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.79,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.66,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"minimum":6.44,"maximum":412.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":412.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.33,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.31,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":305.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.19,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6.44,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.31,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.17,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":202.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.05,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.33,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.0,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":281.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.19,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":9.46,"maximum":606.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":518.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.35,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.39,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.74,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9.46,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.69,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":330.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":606.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.05,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.35,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.0,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":414.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.35,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":192.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.94,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":211.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":74.85,"maximum":1833.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1833.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":326.44,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":260.09,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":426.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":910.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":354.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":726.90,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":447.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.89,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.5,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.85,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":691.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.58,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":389.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":1211.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.87,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1627.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.87,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":330.87,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":142.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.14,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.56,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1003.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1674.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.1,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":357.42,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.62,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":93.0,"maximum":5557.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":4524.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.00,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.61,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":932.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2776.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":684.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":808.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1191.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2561.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":668.90,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":767.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2476.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":903.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":621.68,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1508.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":5557.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":697.38,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":5383.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":642.96,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":737.61,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":93.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.08,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.05,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.6,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":3326.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":5030.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":752.00,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":625.04,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":606.80,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":869.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.76,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":755.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":381.6,"maximum":9634.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":7929.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1345.40,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2042.69,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1391.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4704.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":822.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1394.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1178.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4596.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1650.13,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1898.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":381.6,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2394.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1409.3,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1857.01,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9563.5,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1482.50,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":6654.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":716.71,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1330.52,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":833.07,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.44,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":3530.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9634.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1432.41,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1318.32,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1124.09,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1445.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1140.65,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1560.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":822.0,"maximum":23157.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":23157.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1600.28,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1264.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11465.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2924.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1150.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3418.88,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2377.99,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":867.87,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":9577.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2052.18,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1691.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1497.91,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1287.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1735.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1731.11,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":822.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"minimum":547.88,"maximum":23941.20,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4528.70,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4317.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23941.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3909.27,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6712.50,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2914.22,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":9880.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4617.92,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":547.88,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8266.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3302.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7105.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":119.57,"maximum":4469.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":518.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":194.74,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":577.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4469.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":804.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.79,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":299.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.57,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1234.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":234.07,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.90,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.2,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1939.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":499.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.06,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":91.44,"maximum":1995.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1675.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":402.68,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":384.22,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":232.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1158.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":286.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1207.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":400.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.96,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1047.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":824.22,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":394.10,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":468.24,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1274.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":470.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.44,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.2,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.44,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1995.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1994.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":285.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":367.18,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.51,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":568.62,"maximum":5064.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":3047.24,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":659.42,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1894.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":665.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":928.81,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1219.53,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1257.37,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3870.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":668.16,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2183.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1630.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5064.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":722.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":740.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":568.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"minimum":470.44,"maximum":25190.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2742.51,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3240.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4051.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3528.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1879.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2544.63,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1772.52,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":25190.55,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3799.13,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":470.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":8210.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1641.77,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1490.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1387.52,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3194.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"minimum":1920.08,"maximum":3273.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1920.08,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2862.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3273.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"minimum":474.68,"maximum":1012.0,"setting":"outpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":496.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1012.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":474.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"minimum":324.32,"maximum":2755.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":424.32,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":562.18,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1039.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1562.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":470.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":905.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.59,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":584.69,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":621.22,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2755.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":790.73,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":438.76,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.32,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":561.4,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2234.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":629.60,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":459.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":492.18,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":625.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":2.32,"maximum":10238.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":10238.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1272.73,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1466.57,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2394.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3608.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1872.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1272.04,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1953.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":5165.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1753.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1238.47,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3626.48,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":5776.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2515.94,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1561.00,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1661.12,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1880.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4782.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2645.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1295.07,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1163.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1173.26,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1606.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"minimum":100.0,"maximum":21372.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2658.1,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2571.02,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4196.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5715.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1487.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1664.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10572.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2823.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2179.42,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2268.97,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":21372.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.29,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":404.43,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":17046.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":960.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2456.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1971.97,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2276.32,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2449.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"minimum":3.01,"maximum":21641.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3541.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7901.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":724.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.01,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3088.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":21641.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3183.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2376.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"minimum":3903.06,"maximum":10138.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3917.46,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5629.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10138.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5174.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3903.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5511.67,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7630.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5594.66,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5001.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5555.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"minimum":2918.61,"maximum":6910.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6910.61,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2918.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"minimum":275.0,"maximum":275.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":275.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":163.8,"maximum":6228.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.53,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":428.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.8,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.75,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.8,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":6228.9,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":447.85,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":246.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"minimum":95.02,"maximum":1842.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":829.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.72,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.0,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":592.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":563.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.82,"estimated_amount":624.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":232.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.1,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":536.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":232.82,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":345.02,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":150.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.25,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":195.91,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":1842.4,"methodology":"percent of total billed charges"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1486.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.29,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.93,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":517.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"minimum":181.30,"maximum":1858.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":948.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.30,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.82,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":534.50,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.59,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.68,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.89,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1858.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1026.48,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":403.6,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":251.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1060.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":319.58,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.05,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"minimum":576.25,"maximum":8176.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":8176.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.17,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1355.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4773.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1385.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1184.32,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2151.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1608.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1208.82,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1227.23,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":576.25,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":8132.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4663.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1297.16,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1585.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1459.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"minimum":668.85,"maximum":15212.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":14987.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2369.43,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2833.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5265.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":861.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1424.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4820.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2658.45,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2681.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":7868.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2266.51,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2823.00,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7556.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":7318.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":15212.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1778.53,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":10293.5,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":668.85,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":845.15,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":7701.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":11628.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2145.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2821.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2357.51,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2764.66,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4183.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"minimum":868.92,"maximum":28833.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":22488.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3725.2,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6270.69,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10238.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10615.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3082.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5038.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6272.09,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7859.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4849.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6195.93,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8926.32,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":8113.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.22,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3427.74,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":868.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":28833.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4254.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6128.33,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4544.58,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6177.33,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7896.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"minimum":1829.97,"maximum":47056.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":28855.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6830.69,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12003.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25221.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7752.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14678.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11808.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6725.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12005.76,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13091.73,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":25149.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6984.56,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6940.54,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1829.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":47056.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7192.65,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11967.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6946.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11742.36,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16586.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"minimum":13791.13,"maximum":18896.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15956.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18896.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15249.56,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13791.13,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16563.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"minimum":68.53,"maximum":776.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":547.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.1,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":303.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":272.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.44,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":420.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.1,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.94,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":169.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":299.77,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.1,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.2,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.53,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":776.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.1,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":238.99,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128.63,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.22,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"minimum":1361.0,"maximum":11813.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1617.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11813.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1521.43,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1640.70,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1515.45,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2262.30,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6078.29,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1361.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"minimum":1769.39,"maximum":18997.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2093.13,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3144.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5596.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1769.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3266.11,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3131.5,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3342.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":18997.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2913.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1928.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2940.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"minimum":2287.47,"maximum":6698.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3623.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6698.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5896.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5804.03,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2287.47,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5848.14,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2338.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"minimum":119.49,"maximum":10974.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":9245.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1660.04,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5492.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2407.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1869.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.49,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2407.66,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":5772.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2407.66,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1209.50,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":461.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":10974.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2407.66,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1977.7,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"minimum":260.44,"maximum":5672.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":5672.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4367.14,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":640.76,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":260.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1156.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"minimum":317.8,"maximum":12805.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":4897.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1522.87,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1389.95,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2200.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4034.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1725.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1178.11,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1258.01,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1184.07,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7356.0,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1912.23,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":12805.2,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1725.54,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1158.28,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.8,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":3850.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1175.60,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1198.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1103.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"minimum":619.92,"maximum":22494.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":7903.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1597.26,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4755.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5545.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1876.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15686.34,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1804.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1815.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2710.88,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":22494.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2501.72,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1460.16,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":619.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9199.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1762.50,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2914.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1603.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2918.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"minimum":617.96,"maximum":8876.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":7949.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1533.58,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4237.84,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8649.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4562.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2501.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1476.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8408.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4684.26,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2823.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1557.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5003.3,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":8876.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2501.72,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1537.68,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":769.42,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":617.96,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7248.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1523.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4143.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1587.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"minimum":443.77,"maximum":3784.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2224.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1734.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":443.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1627.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":568.26,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":841.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":531.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":548.42,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":517.53,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2611.66,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":3784.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.90,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1172.18,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":549.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"minimum":915.32,"maximum":4698.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2885.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4698.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":915.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1088.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3088.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1261.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1446.29,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1326.68,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1408.23,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1712.56,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1664.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":3388.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1117.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1191.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"minimum":478.19,"maximum":24766.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2070.66,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2853.69,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4707.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7399.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":925.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1889.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3572.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2613.8,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3582.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":6813.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3043.62,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2606.92,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4478.05,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1985.68,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":478.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":24766.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2096.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2824.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1951.82,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2589.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"minimum":2246.57,"maximum":22017.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4881.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13335.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4931.85,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4879.5,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2246.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":22017.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4725.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7194.60,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4984.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"minimum":141.85,"maximum":21359.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2945.78,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2822.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13876.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2947.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3493.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2899.66,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4286.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4074.44,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2702.59,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6419.0,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3852.36,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":4211.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5890.72,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.04,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":714.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":21359.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3679.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2816.07,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4197.41,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2678.09,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4210.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"minimum":4379.82,"maximum":38347.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7538.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4379.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4900.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4944.21,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":38347.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4948.71,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7472.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4900.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"minimum":1400.22,"maximum":45284.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5861.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21984.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8994.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9964.41,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2724.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10689.01,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9764.44,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25385.95,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":45284.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12636.41,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13364.77,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9681.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9292.43,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9730.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"minimum":5534.28,"maximum":54753.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5534.28,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15861.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54753.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13918.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15861.7,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12988.44,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15864.91,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":18804.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17555.65,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13648.5,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12441.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12689.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Implantation Wireless PA Pressure Monitor","code_information":[{"code":"5200","type":"APC"}],"standard_charges":[{"minimum":23470.16,"maximum":26305.72,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23548.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23470.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26305.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"minimum":6412.47,"maximum":37623.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":37623.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6412.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15198.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":22581.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"minimum":1466.9,"maximum":135071.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9713.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49916.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37178.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21483.85,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17357.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21262.3,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":135071.1,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20464.58,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1627.55,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1466.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11942.03,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21475.80,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18588.66,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22260.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"minimum":54.16,"maximum":21182.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14923.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6147.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7419.82,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":21182.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10392.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4514.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7566.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4557.57,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7464.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"minimum":8694.73,"maximum":78960.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8694.73,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9527.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39857.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9659.22,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14291.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9677.60,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":78960.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":62494.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9682.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11382.22,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9598.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"minimum":7174.42,"maximum":133975.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17625.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85489.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17697.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17522.8,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":133975.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7174.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17276.70,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18669.1,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17358.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"minimum":17305.45,"maximum":71449.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21362.3,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":71449.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21345.0,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17305.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"minimum":16710.40,"maximum":215500.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23850.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154757.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21869.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29685.44,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35900.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30314.52,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":215500.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16710.40,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30222.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30114.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"minimum":417.11,"maximum":10377.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":838.56,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":899.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2918.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10377.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7858.52,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":868.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":417.11,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1080.35,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":945.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1328.02,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":755.77,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3128.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":588.66,"maximum":6178.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":4420.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":756.51,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":819.98,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1339.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2899.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1041.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3523.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3137.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":815.25,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1820.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2880.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.60,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":842.87,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2493.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":4949.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1065.11,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1082.47,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2255.64,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":626.06,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":588.66,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":6178.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4795.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":818.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.23,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":928.11,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":785.77,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1118.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":1024.32,"maximum":14451.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1183.59,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1697.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3372.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3195.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5021.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1376.98,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1910.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1024.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1605.74,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1197.73,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":14451.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3195.91,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1642.41,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":8498.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1792.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1114.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1723.22,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3640.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"minimum":1935.42,"maximum":8938.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3125.85,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2821.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5967.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1935.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2994.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3137.78,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4525.79,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":8938.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3696.71,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3469.36,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3292.79,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2963.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2970.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":223.84,"maximum":6706.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":6706.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1138.59,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":826.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3588.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1045.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1284.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3294.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":826.74,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1223.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":826.74,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6256.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":3486.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3518.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.69,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1163.08,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":263.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.84,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":902.22,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":4085.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":5632.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1142.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":826.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1138.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":836.11,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1181.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":756.9,"maximum":7569.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":7569.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1232.52,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1067.46,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2077.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3806.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1167.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2764.11,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5309.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1067.46,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1579.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":3590.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1292.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1067.46,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4492.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":4517.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.69,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2479.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.69,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1416.0,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2417.58,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":756.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":6643.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.69,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1198.16,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1310.11,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1067.46,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1525.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"minimum":1710.91,"maximum":16954.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3539.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16954.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2358.09,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2547.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2441.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1710.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"minimum":3958.07,"maximum":14151.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":9752.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7373.02,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4575.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14092.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3958.07,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4970.11,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":14151.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5052.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"minimum":335.63,"maximum":13761.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3480.68,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3023.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10105.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1739.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2860.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6510.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2835.5,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":7156.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.63,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":13761.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2884.51,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2521.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2885.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"minimum":1071.38,"maximum":19825.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":16260.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3284.04,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5219.34,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8396.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11689.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3711.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6629.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4955.56,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7517.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3733.22,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4944.30,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12625.0,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7935.05,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":18013.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5116.68,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4119.8,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":15112.3,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1715.82,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1071.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":19825.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3977.91,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5221.34,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3779.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4925.34,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4534.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"minimum":155.0,"maximum":41117.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":41117.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5125.96,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8828.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17208.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2261.00,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5255.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9328.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9081.86,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6031.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8963.46,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":25251.5,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":28310.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3647.75,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2074.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":26250.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8617.98,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5551.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9311.36,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10687.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"minimum":125.57,"maximum":2564.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.98,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":343.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":552.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.78,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":823.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2564.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":318.29,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":125.57,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":249.64,"maximum":3304.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1084.10,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":617.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1366.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":393.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2290.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":586.28,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":877.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":3304.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2420.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":592.82,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2063.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2141.94,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.2,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.51,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":249.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1983.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1954.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":593.31,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":411.64,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494.33,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"minimum":108.78,"maximum":7069.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":6361.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":941.33,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1800.42,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2939.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4008.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":807.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3093.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5699.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1843.14,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":643.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2658.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1615.38,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1597.44,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":5515.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2518.36,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1566.7,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7069.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2141.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1746.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1178.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1473.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":1303.05,"maximum":24644.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":7239.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1677.92,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2522.77,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5149.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4923.40,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1303.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1390.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2883.96,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4665.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.11,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3049.84,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7751.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":24644.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1954.04,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2730.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7633.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1740.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3039.36,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1419.33,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2859.46,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3906.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"minimum":28.0,"maximum":15390.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1485.82,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4459.94,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7642.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5554.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1810.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2754.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2090.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4411.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":15390.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1569.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4411.06,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11296.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":4852.5,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":11748.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2360.68,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":406.41,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":4800.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":10292.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1532.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4435.56,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3611.4,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1630.90,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4188.17,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5326.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"minimum":766.64,"maximum":23909.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":766.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12509.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":7638.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8144.11,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":23909.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8336.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3711.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"minimum":6627.16,"maximum":18305.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9808.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18209.59,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18305.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18001.74,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6627.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"minimum":2294.22,"maximum":2599.11,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2294.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2599.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":3.0,"maximum":2332.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1824.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.58,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.76,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1035.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":343.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":980.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1169.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.2,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.89,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.46,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":1132.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.19,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1016.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":517.7,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.58,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":2332.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.23,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2073.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.90,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.7,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"minimum":113.84,"maximum":6142.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":796.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185.12,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1587.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":959.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2027.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.85,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":682.2,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.85,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":6142.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.25,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":667.49,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":530.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"minimum":64.82,"maximum":3839.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":428.61,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":314.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1709.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":249.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":755.02,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":445.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.96,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3839.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":647.58,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.74,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1290.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":477.97,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":412.26,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"minimum":450.15,"maximum":8736.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":6109.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1468.74,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2474.16,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4376.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5545.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1387.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2184.56,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4184.29,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1657.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2708.16,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6818.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":6418.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2845.04,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1578.7,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.15,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":8736.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1849.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2410.46,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1738.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"minimum":1693.97,"maximum":23173.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":23173.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3599.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6587.70,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1693.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1847.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4035.00,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":6415.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2845.04,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6318.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9428.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.84,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4239.75,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2066.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"minimum":1287.52,"maximum":10345.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1658.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4960.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1405.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1477.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1287.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1437.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":10345.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1638.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1597.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1485.5,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1452.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"minimum":325.0,"maximum":1884.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.0,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1884.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"minimum":60.03,"maximum":1681.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1681.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.34,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":388.68,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":633.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":853.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":507.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":330.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1243.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.49,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":73.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":325.68,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":367.29,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":791.0,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":507.95,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":908.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":623.37,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":333.26,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.76,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.4,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.03,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1210.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1536.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":265.85,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.82,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":318.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.86,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"minimum":613.84,"maximum":2580.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1483.02,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":691.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2566.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":835.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2580.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":646.80,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":625.55,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1391.8,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":651.82,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1182.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2193.6,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":613.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":749.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"minimum":1164.8,"maximum":9259.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":9259.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1344.10,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3307.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1164.8,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1388.35,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1330.37,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":8657.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9049.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1329.59,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1406.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2195.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"minimum":2954.7,"maximum":2954.7,"setting":"outpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2954.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"minimum":13027.33,"maximum":13027.33,"setting":"outpatient","payers_information":[{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13027.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laser Eye Procedures","code_information":[{"code":"5481","type":"APC"}],"standard_charges":[{"minimum":289.77,"maximum":1134.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":869.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.77,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":525.8,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1111.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.56,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":420.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":526.23,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":295.57,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":503.17,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":751.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"minimum":91.0,"maximum":6728.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1196.19,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2050.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3711.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1214.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6350.11,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1838.47,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2048.82,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":3781.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":6728.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1048.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2049.16,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1139.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1813.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"minimum":2117.9,"maximum":7791.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3685.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7791.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2508.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3683.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2350.45,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3520.77,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2117.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2351.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3680.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2435.86,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3618.32,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5411.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"minimum":2751.6,"maximum":4585.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2751.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4458.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4340.66,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3725.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3092.48,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4585.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"minimum":232.7,"maximum":1720.64,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1471.74,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.89,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":488.48,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.18,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":232.7,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1720.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5502","type":"APC"}],"standard_charges":[{"minimum":559.13,"maximum":1339.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":916.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1313.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1339.43,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":559.13,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":692.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":919.82,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":916.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"minimum":1681.06,"maximum":9845.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2024.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5616.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6088.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1902.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1796.08,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9845.6,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2072.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1681.06,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1783.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5504","type":"APC"}],"standard_charges":[{"minimum":2154.68,"maximum":13685.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2154.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13685.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2801.77,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":12846.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3446.56,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3503.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":7.76,"maximum":641.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":641.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":105.82,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.36,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":184.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.88,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":122.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.76,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":389.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.88,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":621.5,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":446.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.60,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":621.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.92,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.24,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":194.67,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.01,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":501.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":552.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.51,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.69,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":118.28,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.36,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":54.55,"maximum":1304.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":846.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.3,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.45,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.82,"estimated_amount":580.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.32,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":378.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.3,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.32,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":1304.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.27,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":809.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173.0,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.3,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55.8,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.56,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.55,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":466.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":888.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.86,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":198.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.19,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.32,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":92.42,"maximum":2999.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":2999.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.18,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.88,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":362.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1517.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":922.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1872.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.29,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":759.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.66,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":696.0,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.56,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":600.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":318.85,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.18,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.61,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.42,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1819.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2864.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.18,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":555.06,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.38,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":83.2,"maximum":3320.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":2879.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.14,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":499.03,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":815.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1883.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":753.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1060.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":993.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":478.91,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":382.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":478.87,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1273.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":1823.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.05,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3320.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":581.05,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.14,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.85,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.2,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1587.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2720.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":479.17,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":500.96,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":478.91,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":97.21,"maximum":2651.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1923.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.52,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.88,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1378.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":419.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":680.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":610.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2421.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.88,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.91,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2096.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.59,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":646.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":1730.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":417.89,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2651.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.45,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.74,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.21,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.68,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":579.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2206.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.3,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":458.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":170.96,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":307.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":148.96,"maximum":4118.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":3919.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":668.72,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":347.87,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":570.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1886.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":477.23,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":669.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1941.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":320.38,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":386.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.25,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2093.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":669.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.16,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1866.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":3852.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.76,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3186.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":669.24,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.02,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":355.85,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.96,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4118.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":723.45,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.3,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.63,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.3,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"minimum":167.51,"maximum":6445.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":5539.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":929.24,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2930.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1181.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2439.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.17,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":525.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1199.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":726.77,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":4589.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1146.65,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1181.18,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.51,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":192.73,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":6445.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":929.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":705.09,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1204.81,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":715.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":301.55,"maximum":4096.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":4096.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":508.95,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1446.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":382.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":655.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2216.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.55,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":548.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":698.75,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":368.47,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":1254.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2321.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.48,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":415.03,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":506.91,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":2258.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1170.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":559.20,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":368.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":498.32,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.22,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":444.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":245.25,"maximum":4025.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":3200.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":737.30,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.42,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":798.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2297.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":532.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1026.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.22,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":690.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":427.03,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3714.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":559.11,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":748.93,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.25,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4025.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":603.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":763.91,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":382.61,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":395.87,"maximum":11962.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":9872.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1820.51,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1554.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6705.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":880.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2311.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3405.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6282.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1406.19,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1900.47,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1857.67,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1290.46,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3915.0,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1497.99,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":11962.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1457.64,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2311.7,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":594.46,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.87,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":5881.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9845.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1768.13,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1285.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1856.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1287.08,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2042.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"minimum":1144.86,"maximum":9511.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":4682.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1593.18,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1415.16,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2310.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6099.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1639.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1593.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3048.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4058.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1411.91,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2091.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":5318.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1593.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1415.15,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":6115.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":7942.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1589.9,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3005.77,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3008.72,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":5149.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9511.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1144.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1415.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1625.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1411.91,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2017.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"minimum":466.41,"maximum":16718.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15208.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3849.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":466.41,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2782.25,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":16718.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2211.22,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":609.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"minimum":437.83,"maximum":5059.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":437.83,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5059.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2199.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2557.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3088.45,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2470.06,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3826.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":745.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1032.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"minimum":90.0,"maximum":41008.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":16256.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4276.61,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5786.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16321.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6455.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3983.07,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3114.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6988.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4148.97,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2019.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5405.4,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1226.68,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1171.52,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":41008.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5326.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4237.17,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6581.47,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1818.76,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"minimum":274.12,"maximum":18377.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":780.13,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2228.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3592.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":971.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":655.72,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":730.49,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":940.7,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":982.15,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.12,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":18377.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":607.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1811.94,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":578.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1459.55,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5921.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"minimum":750.09,"maximum":19216.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2550.22,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4731.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19216.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3290.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3164.88,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11803.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4192.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4298.96,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4674.72,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3620.7,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3987.22,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":750.09,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4477.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"minimum":1491.62,"maximum":9317.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1491.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9317.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8654.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 7 Radiation Therapy","code_information":[{"code":"5627","type":"APC"}],"standard_charges":[{"minimum":7808.42,"maximum":12377.12,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12377.12,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8938.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7808.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"minimum":759.85,"maximum":1194.06,"setting":"outpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":759.85,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1194.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":18.05,"maximum":911.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":911.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.05,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.99,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.02,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":196.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.41,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.99,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":309.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.02,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.36,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"minimum":14.01,"maximum":1017.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":174.99,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1017.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.64,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.5,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":244.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":18.03,"maximum":3690.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":3690.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":410.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":707.48,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":467.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":684.20,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":624.14,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.03,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":444.71,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.0,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":334.61,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.30,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":421.88,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":535.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"minimum":18.86,"maximum":4744.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.02,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.53,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.44,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":253.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4744.41,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.53,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.16,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.38,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.0,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":18.06,"maximum":530.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":404.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.86,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.14,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.84,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63.73,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":169.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.59,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.07,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":197.85,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":220.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":164.85,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.76,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":470.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.65,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.2,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":530.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":508.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.91,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.08,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.64,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63.99,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":282.42,"maximum":33874.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":12457.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":722.83,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":718.93,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33874.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2140.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1966.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":730.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":660.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10884.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":861.26,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1012.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2317.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":770.8,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":761.46,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31465.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":13387.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3145.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":874.84,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":777.07,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":896.60,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.42,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":462.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2384.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1306.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":699.35,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1849.75,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":739.4,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":778.22,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8356.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"minimum":1076.0,"maximum":66599.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":30945.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4028.55,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5863.0,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2349.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22378.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3075.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10054.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7681.96,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1076.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":26414.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5128.87,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6610.59,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":66599.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6715.95,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":7536.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":34192.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7460.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7577.45,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5662.14,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8479.3,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2379.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":32.98,"maximum":584.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":556.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.9,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.20,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":363.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":334.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.92,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":158.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.9,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.3,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":141.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.9,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.77,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":584.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.03,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.8,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.7,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":69.78,"maximum":2644.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":2644.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.34,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.93,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":464.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1359.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":489.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.93,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":855.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.19,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.93,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":2416.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2042.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":260.26,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.2,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.65,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.14,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":358.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":2284.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.1,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":267.9,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.93,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":406.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"minimum":45.34,"maximum":1554.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1554.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.37,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":473.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":256.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":383.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.46,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.07,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":415.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.82,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.2,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":641.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":151.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.23,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":170.84,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.9,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.18,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"minimum":315.86,"maximum":4669.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":4669.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.51,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":896.76,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1544.10,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2759.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":954.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1542.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3054.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":828.96,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1311.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.51,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":885.79,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":3601.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.51,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.81,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4063.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":800.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":891.64,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":812.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":804.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":7.41,"maximum":1006.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":49.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.69,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.57,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.41,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":357.51,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":243.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1006.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.70,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":52.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55.85,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.71,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.39,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"minimum":17.50,"maximum":132.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17.50,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.77,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.46,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.24,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.0,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":132.8,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":10.94,"maximum":424.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":184.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.08,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":118.22,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":228.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.46,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":124.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.22,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.57,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":257.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.16,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.14,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19.10,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":424.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.67,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.72,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":22.52,"maximum":3881.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":1687.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.07,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":391.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":565.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.77,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":1412.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.4,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.55,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3881.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":2156.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1409.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128.3,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.01,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22.52,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.28,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":568.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1417.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.00,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.1,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.07,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"minimum":92.43,"maximum":1630.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":542.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":685.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.08,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":529.60,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":357.37,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":640.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1630.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.28,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":288.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"minimum":13.65,"maximum":128.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":110.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.8,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.11,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":69.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.65,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.86,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.06,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":76.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.27,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.65,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14.45,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.56,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":74.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":128.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.65,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.76,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.29,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"minimum":6.79,"maximum":450.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.19,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":270.14,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6.79,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":450.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.07,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"minimum":35.0,"maximum":1000.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":571.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":809.68,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.13,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.83,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":35.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1000.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":797.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.64,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":416.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"minimum":92.92,"maximum":14332.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":745.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2470.20,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":725.15,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3983.79,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":590.82,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2755.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":781.29,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":14332.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.2,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":479.01,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1039.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"minimum":92.95,"maximum":1661.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.96,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.80,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.57,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":173.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.74,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.0,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.93,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1661.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.31,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Manipulation Therapy","code_information":[{"code":"5811","type":"APC"}],"standard_charges":[{"minimum":13.69,"maximum":171.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":171.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.52,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15.48,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.23,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.95,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.52,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.68,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":82.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":56.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.48,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.25,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":27.0,"methodology":"percent of total billed charges"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.2,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":163.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.52,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22.54,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.05,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.95,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"minimum":93.08,"maximum":93.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"minimum":20.2,"maximum":533.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":533.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.76,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.55,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":174.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.63,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.17,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":92.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.87,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.57,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":350.0,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.76,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":493.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128.0,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":67.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.2,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20.2,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":191.5,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":389.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.64,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.76,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.68,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.43,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"minimum":20.0,"maximum":368.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":275.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.95,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":163.22,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":190.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.93,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.31,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.94,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":368.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":192.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":151.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.95,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":20.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.51,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Composite","code_information":[{"code":"8004","type":"APC"}],"standard_charges":[{"minimum":66.41,"maximum":694.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":694.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":290.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":631.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.94,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.4,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":238.11,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":440.1,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"CT and CTA without Contrast Composite","code_information":[{"code":"8005","type":"APC"}],"standard_charges":[{"minimum":95.66,"maximum":7233.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":848.64,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":446.0,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":753.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2544.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":927.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.66,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":319.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2234.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1330.29,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.23,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":4316.5,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1107.86,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.80,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7233.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1110.92,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"CT and CTA with Contrast Composite","code_information":[{"code":"8006","type":"APC"}],"standard_charges":[{"minimum":407.61,"maximum":10000.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":8823.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1405.69,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":409.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4447.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":693.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1572.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4570.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":411.59,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":609.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2155.20,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":411.96,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4023.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":7148.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":10000.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516.63,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1731.14,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":487.14,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":8424.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1422.81,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":407.61,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2099.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":407.9,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":580.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"MRI and MRA without Contrast Composite","code_information":[{"code":"8007","type":"APC"}],"standard_charges":[{"minimum":322.02,"maximum":7134.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":5409.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1088.36,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":498.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2808.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1284.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1202.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":405.14,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":739.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":3382.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1088.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":322.02,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2808.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":479.02,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1088.36,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":385.5,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":3516.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":7134.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2230.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":499.25,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1110.12,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":501.8,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":709.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"MRI and MRA with Contrast Composite","code_information":[{"code":"8008","type":"APC"}],"standard_charges":[{"minimum":291.44,"maximum":5971.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2225.15,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.87,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2822.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1052.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1385.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2397.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2050.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":801.75,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":2660.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1271.79,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":795.36,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.76,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2200.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":891.08,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1924.62,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":449.78,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":5971.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2117.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1057.72,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1451.11,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":721.18,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":789.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mental Health Services Composite","code_information":[{"code":"8010","type":"APC"}],"standard_charges":[{"minimum":37.31,"maximum":9756.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":7666.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.31,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1109.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7818.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":498.55,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":797.68,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":2589.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":463.84,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":9756.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1160.27,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":469.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Comprehensive Observation Services","code_information":[{"code":"8011","type":"APC"}],"standard_charges":[{"minimum":264.95,"maximum":15772.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":8537.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1537.23,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2475.99,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3792.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8400.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1683.52,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2534.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7429.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9661.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2400.91,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1904.0,"methodology":"other"},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":9199.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2080.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2377.98,"methodology":"other"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1307.43,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":10920.5,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2067.81,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2014.82,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":980.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1140.28,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1217.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":15772.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2053.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2358.39,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2021.78,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2036.52,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2327.51,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2674.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mmrv vaccine sc","code_information":[{"code":"9011","type":"APC"}],"standard_charges":[{"minimum":74.29,"maximum":377.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":144.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.29,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":377.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":268.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Thyrotropin injection","code_information":[{"code":"9108","type":"APC"}],"standard_charges":[{"minimum":2219.24,"maximum":9615.02,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9615.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2219.24,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2741.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Triptorelin pamoate","code_information":[{"code":"9122","type":"APC"}],"standard_charges":[{"minimum":2312.35,"maximum":2470.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2470.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2312.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"minimum":208.97,"maximum":4825.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":382.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2712.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2627.56,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3272.81,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":4825.0,"methodology":"percent of total billed charges"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj acetaminophen -fresenius","code_information":[{"code":"9143","type":"APC"}],"standard_charges":[{"minimum":2961.87,"maximum":11388.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4382.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11388.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6433.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2961.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj crotalidae im f(ab')2 eq","code_information":[{"code":"9188","type":"APC"}],"standard_charges":[{"minimum":3283.23,"maximum":3283.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3283.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, udenyca 0.5 mg","code_information":[{"code":"9195","type":"APC"}],"standard_charges":[{"minimum":59.93,"maximum":4030.0,"setting":"outpatient","payers_information":[{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2705.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1587.76,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4030.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1657.04,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.93,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1654.11,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2308.83,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2947.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate suspnsion","code_information":[{"code":"9217","type":"APC"}],"standard_charges":[{"minimum":958.64,"maximum":24284.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2985.02,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1125.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6918.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":958.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1047.93,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2662.85,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":24284.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.93,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3029.44,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":963.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Panitumumab injection","code_information":[{"code":"9235","type":"APC"}],"standard_charges":[{"minimum":21727.84,"maximum":27597.46,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21727.84,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27597.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Eculizumab injection","code_information":[{"code":"9236","type":"APC"}],"standard_charges":[{"minimum":28452.29,"maximum":28452.29,"setting":"outpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28452.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Romiplostim injection","code_information":[{"code":"9245","type":"APC"}],"standard_charges":[{"minimum":7607.33,"maximum":7607.33,"setting":"outpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7607.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, amisulpride, 1 mg","code_information":[{"code":"9247","type":"APC"}],"standard_charges":[{"minimum":1384.0,"maximum":13062.66,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13062.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2241.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1384.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8282.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4454.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, acetaminophen (hikma)","code_information":[{"code":"9282","type":"APC"}],"standard_charges":[{"minimum":12262.34,"maximum":12262.34,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12262.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ipilimumab injection","code_information":[{"code":"9284","type":"APC"}],"standard_charges":[{"minimum":23991.93,"maximum":23991.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23991.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, clindamycin phosp 300mg","code_information":[{"code":"9291","type":"APC"}],"standard_charges":[{"minimum":2429.01,"maximum":27499.0,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6728.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2429.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":27499.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj. teprotumumab-trbw 10 mg","code_information":[{"code":"9355","type":"APC"}],"standard_charges":[{"minimum":45304.99,"maximum":45304.99,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45304.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. lurbinectedin, 0.1 mg","code_information":[{"code":"9389","type":"APC"}],"standard_charges":[{"minimum":15980.17,"maximum":15980.17,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15980.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, nyvepria","code_information":[{"code":"9406","type":"APC"}],"standard_charges":[{"minimum":4263.8,"maximum":4263.8,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4263.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, dostarlimab-gxly, 10 mg","code_information":[{"code":"9431","type":"APC"}],"standard_charges":[{"minimum":14224.82,"maximum":14224.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14224.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj pegfilgrast ex bio 0.5mg","code_information":[{"code":"9436","type":"APC"}],"standard_charges":[{"minimum":802.53,"maximum":3455.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3447.47,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3455.53,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":802.53,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1354.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"minimum":354.29,"maximum":1731.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":354.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1731.67,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1010.86,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":473.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"minimum":2050.18,"maximum":2050.18,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2050.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"minimum":354.29,"maximum":5132.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":354.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2473.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3371.13,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5132.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2112.76,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":751.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":7.6,"maximum":917.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":917.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.93,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.39,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":79.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.62,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.75,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":133.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.46,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":191.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":916.5,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.67,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":338.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.6,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.92,"methodology":"other"},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":70.0,"estimated_amount":14.0,"methodology":"percent of total billed charges"},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31.62,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.13,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":626.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":482.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.12,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61.7,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53.03,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.86,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":113.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":81.0,"maximum":1926.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":591.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.74,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92.71,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":805.25,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.82,"estimated_amount":474.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":245.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":871.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1373.16,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.72,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":702.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":233.16,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.0,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":1062.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":675.26,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.85,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.23,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":1165.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":1926.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.59,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.98,"methodology":"other"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":337.63,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.04,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.32,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"minimum":29.12,"maximum":409.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":331.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.42,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.86,"methodology":"other"},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.86,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":43.38,"estimated_amount":188.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.86,"methodology":"other"},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":409.0,"methodology":"other"},{"payer_name":"MedCost","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.0,"estimated_amount":217.0,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":391.0,"methodology":"percent of total billed charges"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.07,"methodology":"other"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.42,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.73,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":182.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":347.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.87,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.55,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.86,"methodology":"other"},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"minimum":4.29,"maximum":521.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":76.20,"estimated_amount":139.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":439.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":350.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":277.54,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":521.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.74,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.7,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":100.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.42,"methodology":"other"},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.22,"methodology":"other"},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":42.0,"estimated_amount":276.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":299.22,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.9,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":247.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"minimum":4.63,"maximum":55.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8.97,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4.63,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8.97,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7.67,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.18,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":90.0,"estimated_amount":9.0,"methodology":"percent of total billed charges"},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":55.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.37,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9.15,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"minimum":93.81,"maximum":93.81,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"minimum":877.94,"maximum":3594.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":937.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3594.91,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":877.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":15.46,"maximum":616.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.2,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18.45,"methodology":"other"},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.75,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":80.0,"estimated_amount":33.0,"methodology":"percent of total billed charges"},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72.97,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":284.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"minimum":522.71,"maximum":522.71,"setting":"outpatient","payers_information":[{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":522.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Not Billable to FI","code_information":[{"code":"N907","type":"APC"}],"standard_charges":[{"minimum":2.59,"maximum":261.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.73,"methodology":"other"},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2.64,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","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 Medicaid","plan_name":"Aetna Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"Champva","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eastern Kentucky Correctional Complex","plan_name":"Eastern Kentucky Correctional Complex","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","description":"The modified price is presented in the standard charge value."},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid 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":"Humana Medicaid","plan_name":"Humana Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","description":"The modified price is presented in the standard charge value."},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","description":"The modified price is presented in the standard charge value."},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medcost","plan_name":"Medcost","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","description":"The modified price is presented in the standard charge value."},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"The Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Tricare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","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":"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":"Us Administrator Claims","plan_name":"Us Administrator Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","description":"The modified price is presented in the standard charge value."},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","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":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","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 Medicaid","plan_name":"Aetna Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"Champva","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eastern Kentucky Correctional Complex","plan_name":"Eastern Kentucky Correctional Complex","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","description":"The modified price is presented in the standard charge value."},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid 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":"Humana Medicaid","plan_name":"Humana Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","description":"The modified price is presented in the standard charge value."},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","description":"The modified price is presented in the standard charge value."},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medcost","plan_name":"Medcost","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","description":"The modified price is presented in the standard charge value."},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"The Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Tricare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","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":"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":"Us Administrator Claims","plan_name":"Us Administrator Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","description":"The modified price is presented in the standard charge value."},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","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":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","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 Medicaid","plan_name":"Aetna Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"Champva","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eastern Kentucky Correctional Complex","plan_name":"Eastern Kentucky Correctional Complex","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","description":"The modified price is presented in the standard charge value."},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid 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":"Humana Medicaid","plan_name":"Humana Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","description":"The modified price is presented in the standard charge value."},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","description":"The modified price is presented in the standard charge value."},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medcost","plan_name":"Medcost","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","description":"The modified price is presented in the standard charge value."},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"The Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Tricare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","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":"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":"Us Administrator Claims","plan_name":"Us Administrator Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","description":"The modified price is presented in the standard charge value."},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","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 Medicaid","plan_name":"Aetna Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"Champva","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eastern Kentucky Correctional Complex","plan_name":"Eastern Kentucky Correctional Complex","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","description":"The modified price is presented in the standard charge value."},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid 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":"Humana Medicaid","plan_name":"Humana Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","description":"The modified price is presented in the standard charge value."},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","description":"The modified price is presented in the standard charge value."},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medcost","plan_name":"Medcost","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","description":"The modified price is presented in the standard charge value."},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"The Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Tricare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","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":"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":"Us Administrator Claims","plan_name":"Us Administrator Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","description":"The modified price is presented in the standard charge value."},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Aetna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","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 Medicaid","plan_name":"Aetna Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"A-G Administrators Inc","plan_name":"A-G Administrators Inc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allcare For Seniors","plan_name":"Allcare For Seniors","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliance Coal Health Plan","plan_name":"Alliance Coal Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alternative Serv Conc","plan_name":"Alternative Serv Conc","description":"The modified price is presented in the standard charge value."},{"payer_name":"American Plan Administrators/ Phcs","plan_name":"American Plan Administrators/ Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs","plan_name":"Anthem Bcbs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicaid","plan_name":"Anthem Bcbs Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Medicare Replacement","plan_name":"Anthem Bcbs Medicare Replacement","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Bcbs Of Virginia","plan_name":"Anthem Bcbs Of Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Appalachian Hospice","plan_name":"Appalachian Hospice","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem - KY Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Access/Preferred HMO/PPO/HIC","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HealthKeepers Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway HPN PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Benefit Administrative Systems,Llc","plan_name":"Benefit Administrative Systems,Llc","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bluegrass Care Navigators","plan_name":"Bluegrass Care Navigators","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Ky","plan_name":"Caresource Ky","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource Medicaid","plan_name":"Caresource Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Champva","plan_name":"Champva","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Medicare","plan_name":"Cigna Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eastern Kentucky Correctional Complex","plan_name":"Eastern Kentucky Correctional Complex","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Black Lung","plan_name":"Federal Black Lung","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Blue Cross Blue Shield","plan_name":"Federal Blue Cross Blue Shield","description":"The modified price is presented in the standard charge value."},{"payer_name":"Federal Bureau Of Prison","plan_name":"Federal Bureau Of Prison","description":"The modified price is presented in the standard charge value."},{"payer_name":"Floyd County Detention Center","plan_name":"Floyd County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthsmart (Wells Fargo Charleston)","plan_name":"Healthsmart (Wells Fargo Charleston)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Humana","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid 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":"Humana Medicaid","plan_name":"Humana Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Integrated Medical Solutions","plan_name":"Integrated Medical Solutions","description":"The modified price is presented in the standard charge value."},{"payer_name":"International Benefits Administrators","plan_name":"International Benefits Administrators","description":"The modified price is presented in the standard charge value."},{"payer_name":"K And K Ins Group (School Ins)","plan_name":"K And K Ins Group (School Ins)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kentucky Medicaid","plan_name":"Kentucky Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ky League Of Cities (Klc)","plan_name":"Ky League Of Cities (Klc)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Letcher County Jail","plan_name":"Letcher County Jail","description":"The modified price is presented in the standard charge value."},{"payer_name":"Mca 90 Degree Benefits","plan_name":"Mca 90 Degree Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"MCA 90 Degree Benefits","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medcost","plan_name":"Medcost","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Out Of State","plan_name":"Medicaid Out Of State","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid Virginia","plan_name":"Medicaid Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicaid West Virginia","plan_name":"Medicaid West Virginia","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"Meritain Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"OH Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicaid","plan_name":"Molina Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ntca (National Telecommunication Cooperative Association)","plan_name":"Ntca (National Telecommunication Cooperative Association)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Office Of Vocational Rehabilitation","plan_name":"Office Of Vocational Rehabilitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optima Health Va Mco","plan_name":"Optima Health Va Mco","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum (Va Ccn)","plan_name":"Optum (Va Ccn)","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Passport Medicaid","plan_name":"Passport Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Phcs Multiplan","plan_name":"Phcs Multiplan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pike County Detention Center","plan_name":"Pike County Detention Center","description":"The modified price is presented in the standard charge value."},{"payer_name":"Pikeville Federal Black Lung Office","plan_name":"Pikeville Federal Black Lung Office","description":"The modified price is presented in the standard charge value."},{"payer_name":"Smart Casualty Claims","plan_name":"Smart Casualty Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan","plan_name":"The Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicaid","plan_name":"The Health Plan Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Health Plan Medicare","plan_name":"The Health Plan Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Tricare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Trustmark Small Business Benefits","plan_name":"Trustmark Small Business Benefits","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umr","plan_name":"Umr","description":"The modified price is presented in the standard charge value."},{"payer_name":"Umwa Health And Retirement Funds","plan_name":"Umwa Health And Retirement Funds","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unicare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Shared Services","plan_name":"United Health Shared Services","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"United Healthcare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicaid","plan_name":"United Healthcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Medicare","plan_name":"United Healthcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Mine Workers of America","plan_name":"All Commercial Plans","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":"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":"Us Administrator Claims","plan_name":"Us Administrator Claims","description":"The modified price is presented in the standard charge value."},{"payer_name":"Us Department Of Labor","plan_name":"Us Department Of Labor","description":"The modified price is presented in the standard charge value."},{"payer_name":"VA Premier","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Elite Plus","plan_name":"Virginia Premier Elite Plus","description":"The modified price is presented in the standard charge value."},{"payer_name":"Virginia Premier Health Plan","plan_name":"Virginia Premier Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WellCare","plan_name":"Ambetter All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Commercial","plan_name":"Wellcare Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicaid","plan_name":"Wellcare Medicaid","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wv Unicare (Medicaid)","plan_name":"Wv Unicare (Medicaid)","description":"The modified price is presented in the standard charge value."}]}]}